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TREATISE 

ON 

CONSUMPTION; 

EMBRACING 

AN    INQUIRY    INTO    THE    INFLUENCE    EXERTED    UPON    IT 

BF 

JOURNEYS,  VOYAGES  AND  CHANGE  OF  CLIMATE. 

WITH 

DIRECTIONS  FOR  THE  CONSUMPTIVE 

VISITING     THE     SOUTH     OF     EUROPE, 

AND 

REMARKS  UPON  ITS  CLIMATE. 

ADAPTED     FOR     GENERAL     READERS. 


BY  AVIIililAM    SAVEETSER,  M.  D. 

Late  Professor  of  the  Theory  and  Practice  of  Physic  in  the  University  of  Vermont ; 

Fellow  of  the  American  Academy  of  Arts  and  Sciences,  and  of  the 

Alassachusetts  Medical  Society. 


BOSTON: 

T.  H.  CARTER. . . .  SCHOOL  STREET. 

1836. 


KG 
3/1 

S^l>ec  Cell 

HiefCo// 


Entered  according  to  Act  of  Congress,  i»  the  year  183C, 

By  T.  H.  Cartek, 

lu  the  Clerk's  Office  of  the  District  Court  of  Massachusetts, 


TUTTLE,   WEEKS    AND  DENNETT,  PKINTEES. 


CONTENTS 


Page. 
Introduction,  .  .  .  .  •  •  .9 

CHAPTER   I. 

General  Remarks  on  the  Disease  —  The  Situations  where 
IT  IS  MOST  Prevalent  —  Its  relative  Mortality,        .         13 

CHAPTER  II. 

General  View  of  the  Lungs  and  their  Function,  .  19 

Anatomical  description  of  the  lungs,  .  .  .19 

Physiology  of  the  function  of  respiration,  .  .  22 

CHAPTER  III. 

Pathology  of  Consumption,  or  the  diseased  Change  which 
takes  place  in  the  Lungs,  .  .  .  .28 

Description  of  tubercles,  .  .  .  •  .30 

Tubercles  manifested  in  many  of  the  inferior  animals,      .        33 

CHAPTER  IV. 

Physical  Characters  indicating  a  Predisposition  to  Con- 
sumption —  Relative  Prevalence  of  the  Disease  in  the 
two  Sexes  —  Periods  of  Life  during  which  it  is  most 
Prevalent,  .  .  .  .  .  .  -35 

Physical  signs,  ......        il). 

Relative  prevalence  of  consumption  in  males  and  females,        41 
Periods  of  life  during  which  it  is  most  usually  developed,         44 

CHAPTER  V. 

Hemoptysis,  or  Pulmonary  Hemorrhage,  .  .        46 

Predisposition,  ......  ib. 

Symptoms,  .  ....        47 


IV  CONTENTS. 

Caiiaes,  .  .  .  .  .  .  .50 

liolativo  prevalence  in  tlio  two  soxos,  .  .  .51 

Afros  in  which  in  it  most  coriinioiily  occurs,   .  .  .  ib. 

I*atholof,'y,  or  natiiro  of  tlic  disease,  .  .  ,         il). 

Damper  of  the  disease,  .  .  .  ,  .52 

Treutincnt,  ......         ib. 

CHAPTER  VI. 

History  of  the  Symptoms  of  Consumption,    .  .  .54 

Premonitory  and  early  symptoms,  .  .  .55 

Symptoms  of  the  disease  when  fully  declared,  .  .  60 

CHAPTER  VII. 

Symptoms  of  the  Common  Form  of  the  Disease  concluded,      7'i 
Last  ])eriod  and  termination  of  consumption,  .  .  ib. 

Circumstances  influencing  the  progress  and  phenomena  of 
the  disease,  ......        82 

CHAPTER  VIII. 

Varieties  of  Consumption,  .  .  .  .  .84 

Acute  variety,  ......         ib. 

Chronic  variety,  .  .  .  .  .  .85 

Latent  variety,  ......         87 

Recapitidation  of  some  of  tlie   characteristic  symptoms  of 
consumption,  .  .  .  .  .  .90 

CHAPTER  IX. 

Causes  of  Consumption,  and  Means  of  Prevention,         .  92 
Predisposing  and  occasional  causes,    .             .             .             .  ib. 
Hereditary  origin  of  a  consumptive  predisposition,  and  gen- 
eral remarks  on  the  transmission  of  hereditary  peculiarities,  94 

CHAPTER  X. 

Causes  of  Consumption  continued  —  Those  which  act  in- 
directly, OR  on  the  General  System,  .  .         106 
Climate,           ...             .             .             .  .     ib. 

Insufficient  clothing,  and  undue  exposure,           .            .        107 
Diet, 108 


CONTENTS.  .  V 

Impure  atmosphere,  .  .  .  .  .         1V2 

Want  of  exercise,         .  .  .  .  .  .114 

Intemperance,        ......         115 

Su|)pression  of  habitual  discharges,     ....  IIG 

Unnatural  excesses  of  youth,         .  .  .  .  ib. 

Abuse  of  mercury  and  other  active  medicines,  .  .     ib. 

Hard  water,  .  .  .  .  .  .118 

Excessive  mental  labor,  .  .  .  .  .119 

The  depressing  passions,  ....         12Ji 

CHAPTER  XT. 

Causes  of  Consumption  continued — Those  which  act  more 

directly  on  the  lungs,         .....  155 

Mechanical  and  chemical  causes,             .             .             .  il). 

Stooping,         ...*...  130 

Unnatural  confinement  of  the  chest  by  dress,       .            .  133 
Extraordinary  exertions  of  the  lungs  in  public  speaking, 

playing  on  wind  instruments,  &c.  .  .  .136 

Contagion,              ......  137 

CHAPTER  XII. 

Causes  of  Consumption  concluded — The   Influence  ex- 
ercised BY  other   Diseases  in   the    Production   of  Tu- 
bercles in  the  Lungs,  .....  140 

Hemoptysis,  or  hemorrhage  from  the  lungs,        .  .  ib. 

Lung  fever,  or  common  inflammation  of  the  lungs,  .  141 

Pulmonary  catarrh,  or  cold  on  the  lungs,  .  .         142 

Dyspepsia,  or  chronic  indigestion,      ....  144 

Continued,  remittent  and  intermittent  fevers,       .  .         147 

Small  pox,       .  .  .  .  .  .  .148 

Scarlet  fever,  ......  ib. 

Measles,  .  .  .  .  .  .  ,    ib, 

CHAPTER  XIII. 

Treatment  of  Consumption,  ....  150 

Irritation  on  the  surface  of  the  body,  .  .  .  151 

Diet,  .......  152 

Drinks, 1G3 


VI  CONTENTS, 

CHAPTER  XIV. 

Treatment  ok  Consumption   continued,                .  .         1G3 

Exorcise  and  fresh  air,             .             .             .            .  .     ib. 

Walking,    .             .             .             .            .             .  .107 

Riding  on  horseback,                .            .             .            .  .108 

Killing  in  a  carriage,  and  swinging,           .             .  .         169 

Inhalation  of  vapors  or  volatile  substances,  and  gases,  .  170 

CHAPTER  XV. 

Treatment  of  Consumption  continued,  .  .        172 

Sea  voyages,     .  .  .  .  .  .  .     ib. 

Remarks  on  sea  sickness,  ....         178 

CHAPTER  XVI. 

Treatment  of  Consumption  continued.  —  Change  of  Cli- 
mate, .......         190 

General  remarks  on  the  influence  of  change  of  climate,  ib- 

Character  of  the  climate  to  be  selected,     .  .  .         191 

Period   of  consumption  when    change   of  climate   may  be 
advisable,      .......  194 

CHAPTER   XVII. 

Treatment  of  Consumption  continued,        .         .  .        200 

Directions  for  the  consumptive  travelling  to  the  south  of 
Europe,         .  .  .  .  .  .  .     ib. 

CHAPTER  XVIII. 

Treatment  of  Consumption  continued,  .  .  .  21C 

General  remarks  on  the  climate  of  the  south  of  Europe,  ii). 

South  of  France,  .  .  .  .  .  .221 

Nice,  .......  ib. 

Genoa, 222 

Pisa, 224 

Leghorn,  .......  227 

Florence,    .......  ib. 

Rome,  .......  229 

Naples, 235 


CONTENTS.  Vll 

CHAPTER  XIX. 

Treatmeist  of  Consumption  continued. — Islands  of  Sicily 
AND  Malta,         .....  .  .  240 

Sicily,       .......  ib- 

Palermo,  .  .  .  .  .  .  .245 

Catania,      .......         246 

Syracuse,  .......  247 

Messina,       .......        249 

Malta,  .  .  .  .  .  •  .250 

Conclusion,  ......        251 


INTRODUCTION 


I  AM  not  ignorant  of  the  objections  urged  against 
the  introduction  of  medical  works  to  the  public  gen- 
erally ;  and  well  know  the  hazard  of  countenancing 
the  popular  employment  of  active  medicinal  agents. 
The  disposition  among  mankind  is  already  too  strong 
to  tamper  with  our  art,  to  trifle  with  the  well- 
being  of  the  animal  constitution,  and  needs  be  re- 
pressed rather  than  encouraged.  But  a  brief  state- 
ment of  the  design  and  plan  of  the  present  volume, 
it  is  believed,  will  exempt  it  from  the  objections 
usually  raised  against  works  of  this  character. 

In  the  first  place,  I  shall  give  a  brief  and  general 
history  of  consumption,  and  the  climates  in  which 
it  is  most  prevalent,  its  relative  mortality,  &c. 
Next,  I  shall  introduce  a  general  view  of  the  lungs 
and  their  functions.  Then  the  pathology  or  nature 
of  the  disease  will  be  considered.  The  physical 
characters  indicating  a  tendency  to  consumption. 
Its  relative  prevalence  in  the  two  sexes,  and  the 
2 


10  INTRODUCTION. 

ages  during  which  it  is  most  frequent.  Then  a 
concise  account  will  be  given  of  hemoptysis,  or 
bleeding  from  the  lungs.  Next,  the  causes  of  con- 
sumption, and  their  means  of  prevention,  so  far  as 
known,  will  be  examined.  The  history  of  the 
symptoms  will  next  follow.  Then  an  account  of 
the  diet  and  regimen  best  adapted  to  the  premon- 
itory and  declared  state  of  the  malady.  And  lastly, 
I  shall  particularly  consider  the  influence  exercised 
by  sea  voyages  and  change  of  climate  on  the  disease, 
and  the  period  and  circumstances  in  which  these 
means  will  be  likely  to  exert  a  beneficial  agency, 
and  shall  give  some  necessary  directions  in  regard 
to  them. 

I  shall  purposely  omit  the  consideration  of  active 
medicines,  which  may  be  demanded  in  the  con- 
firmed state  of  the  disease,  being  convinced  that 
these  can  only  be  rightly  and  safely  employed  under 
the  immediate  direction  of  a  medical  attendant. 

The  special  designs  of  the  present  work,  are  to 
make  known  the  causes  of,  and  best  means  of  pre- 
venting the  fatal  malady  under  consideration ;  that 
those  unfortunate  individuals,  especially,  who  bear 
in  their  physical  organization  its  indications,  or 
those  who  are  their  guardians  in  early  life,  may  be 
apprised  of  their  danger,  and  thus  induced  to  a 
seasonable    resort    to    those    preventive    measures 


INTRODUCTION.  11 

which  have  been  found  most  effective  in  raising  the 
energies  of  the  system,  and  repressing  its  diseased 
tendencies.  That  the  premonitory  or  threatening 
signs  of  the  disease  may  also  awaken  an  early 
solicitude,  and  incite  to  a  timely  application  for 
medical  aid.  And  to  communicate  some  little  in- 
formation on  the  question  relating  to  sea  voyages 
and  warm  climates  in  consumption,  which  is  often 
so  momentous  to  the  sick,  and  so  embarrassing  to 
friends. 

Technical  terms  will  be  avoided,  as  far  as  pos- 
sible, in  the  ensuing  volume,  so  that  it  may  readily 
be  comprehended  by  all  who  feel  an  interest  in  its 
subject. 

I  am  not  aware  that  any  work  precisely  of  the 
character  designated  is  now  before  the  public ;  and 
whether  such  a  one  is  wanted,  and  if  so,  whether 
the  present  will  answer  such  want,  the  public  must 
decide.  I  cannot,  however,  but  indulge  the  hope 
that  I  may  be  able  to  impart  some  instruction  to 
that  numerous  and  unhappy  class  of  individuals, 
who  seem  marked  for  the  victims  of  consumption, 
which  may  tend  either  to  prevent  its  development, 
repress  it  in  the  beginning  of  its  course,  or,  if  no 
more,  smooth  the  destined  passage  to  the  grave. 


TREATISE   ON    CONSUMPTION. 


CHAPTER  I. 

GENERAL     REMARKS  ON  THE    DISEASE  THE   SITUATIONS   WHEUE 

IT     IS  MOST  PREVALENT ITS  RELATIVE   MORTALITY. 

CoxsuMPTioM*  may  be  traced  back  to  the  earliest 
periods  of  medical  history.  Hippocrates,  common- 
ly styled  the  father  of  medicine,  and  who  lived  more 
than  four  hundred  years  before  the  Christian  era, 
knew  it,  and  has  well  described  its  melancholy 
course ;  and  though  ages  have  rolled  on  with  all 
their  changes,  this  bane  of  human  life  still  remains 
the  same  —  has  never  abated  in  its  fatality — never 
rested  from  its  work  of  destruction.  No  condition, 
no  period  of  human  life,  can  claim  immunity  from 
its  ravages.  It  respects  not  station,  for  it  is  a  dis- 
ease equally  of  the  rich  and  the  poor.  It  attacks 
childhood  in  its  w'eakness,  youth  in  its  bloom  and 
elasticity,  manhood  in  its  powder,  and  age  in  its  de- 
crepitude. 

It  has  a  range  over  a  wide  extent  of  latitude ; 
visiting  people  dwelling  in  different  climes,  and  of 

'  Phthisis,  Phthisis  puimonalis,  Consumption  and  Pulmonary  Coiisujiip- 
tion,  when  used  in  the  following  pages,  will  express  one  and  the  same 
disease 


14  WHERE    .'SrOST    PREVALENT. 

the  most  dissimilar  manners  and  habits  of  life.  But 
it  is  especially  active  in  what  are  denominated  tem- 
perate climates — more  even  than  under  the  intense 
cold  of  extreme  northern  latitudes.  It  should  be 
borne  in  mind,  however,  that  the  degree  of  latitude 
which  would  be  temperate  in  Europe,  would  be 
very  cold  in  America.  Paris  enjoys  a  temperate 
climate,  and  yet  it  is  two  degrees  farther  north  than 
Quebec. 

The  disease  prevails,  more  or  less,  throughout 
Europe ;  and  has  its  victims  even  under  the  bright 
skies  of  Italy,  and  of  the  islands  and  southern  bor- 
ders of  the  Mediterranean.  It  exists  in  the  island 
of  Madeira,  once  so  celebrated  as  a  residence  for 
the  consumptive,  as  well  as  in  other  islands  of 
the  Atlantic;  and  even  those  between  the  tropics 
are  not  wholly  exempt  from  it.  Its  ravages  in  the 
more  northern  part  of  America  are  but  too  familiar 
to  my  readers. 

High  northern  latitudes,  as  already  remarked, 
where  the  cold  is  intense  and  uniform  for  a  large 
portion  of  the  year,  seem  less  favorable  to  the  pre- 
valence of  consumption,  than  those  which  are  more 
temperate.  In  Russia,  for  example,  the  relative 
proportion  of  deaths  from  it,  is  considerably  less  than 
in  England  or  France,  and  the  result  of  various  in- 
quiries has  satisfied  me  that  it  prevails  less  in  Lower 
Canada  than  in  the  Northern,  or  even  Middle  States. 
Laennec  has  asserted  that  its  frequency  diminishes 
among  the  inhabitants  of  high  mountainous  coun- 


WHERE    MOST    PREVALENT.  15 

tries,  particularly  the  Alps,  whose  winters  are  long 
and  severe. 

Several  causes  may  be  influential  in  giving  this 
greater  immunity  from  consumption  to  the  dwellers 
in  the  severe  climes  of  the  north. 

The  character  of  both  their  soil  and  climate 
necessarily  calls  forth  active  and  laborious  habits  of 
life,  which  increase  all  the  physical  energies,  and 
consequently  the  ability  to  resist  disease.  The 
effect,  too,  of  uniform  and  severe  cold,  especially 
when  associated  with  bodily  activity,  is  to  elevate 
and  strengthen  the  vital  actions.  It  is  the  sudden 
and  great  vicissitudes  of  the  winters  and  springs  of 
temperate  climates,  against  which  the  inhabitants 
cannot  always  be  guarded,  that  are  so  harmful  to 
the  lungs,  and  in  short  to  the  whole  economy.  The 
animal  body  has  w^ithin  itself  a  power  of  adaptation 
to  almost  any  atmospheric  condition,  if  constant,  or 
if  the  variations  are  so  gradual  as  to  allow  time  to 
rally  its  reacting  principle. 

In  cold  countries,  moreover,  every  thing  is  or- 
dered with  special  reference  to  the  effectual  protec- 
tion against  the  severity  of  the  climate.  The  little 
period  of  warmth  and  sunshine  is  passed  mainly  in 
preparation  for  the  long  and  dreary  winter  which  is 
to  ensue.  The  inhabitants  defend  their  bodies  by 
thick  clothing,  and  the  furs  of  animals ;  and  their 
houses  are  so  constructed  as  most  securely  to  shelter 
against  the  cold,  and  by  means  of  stoves  are  con- 
stantly maintained  at  a  high  temperature,  so  that 
the  amount  of  suffering  endured,  may  really  be  no 


16  WHERE    MOST    PREVALENT. 

more,  and  perhaps  in  many  instances  it  is  less,  than 
among  the  people  of  more  temperate  climates,  who 
guard  themselves  less  cautiously  against  the  occa- 
sional rigors  of  their  uncertain  winters. 

The  natives  of  cold  latitudes — or  such  is  in  cor- 
respondence with  my  own  observations — accustom 
themselves  to  warmer  clothing,  even  in  a  like  tem- 
perature, than  those  who  dwell  under  milder  skies. 
A  Canadian  will  often  be  seen  dressed  in  his  winter 
clothing,  his  throat  and  breast  protected  by  a  large 
shawl,  in  a  temperature  in  which  an  inhabitant  of  our 
Middle  States — of  New  York  or  Philadelphia,  for 
example — would  hardly  put  on  an  additional  gar- 
ment, and  the  front  of  his  chest  would,  very  likely, 
be  guarded  only  by  a  thin  linen  shirt. 

Furthermore,  the  air  during  the  cold  of  northern 
winters  is  drier,  and  consequently  conducts  off  the 
animal  heat  less  rapidly  than  the  more  moist  winter 
atmosphere  of  temperate  climes.  It  is  also  sharper 
and  more  exciting,  and  more  certainly  ensures  re- 
action of  the  extreme  vessels  of  the  surface  of  the 
body.  Every  one  knows  how  red  the  face  and 
hands  become,  when  exposed  to  a  dry  and  keen 
winter  air,  and  how  rarely  colds  succeed  to  such 
exposure ;  and,  on  the  contrary,  how  pale  and 
chilled  is  the  surface,  under  the  influence  of  a  cool 
and  damp  atmosphere,  and  how  frequently  colds 
and  pulmonary  affections  are  the  consequence.  We 
are  driven,  too,  to  more  brisk  action  in  a  dry,  sharp 
air,  to  excite  the  circulation  and  overcome  the  pain- 
ful sense  of  cold  on  the  surface,  than  when  under 


RELATIVE    MORTALITY. 


17 


the  depressing  influence  of  a  damp  and  chilly  atmos- 
phere, which  seems  to  impel  all  the  blood  to  the 
interior  of  the  body.  Who  does  not  experience 
better  health  and  spirits,  and  a  stronger  disposition 
to  action,  on  a  clear,  cold  December's  day,  than 
when  acted  upon  by  our  chilling  easterly  winds  of 
spring  ? 

As  society  advances  in  refinement  and  luxury, 
the  causes  of  consumption  become  multiplied,  and 
the  disease  is  consequently  more  prevalent  than 
among  people  whose  minds  are  more  calm,  and 
whose  habits  more  primitive  and  simple. 

Various  computations  have  been  made  of  the 
relative  sum  of  mortality  from  consumption  in  vari- 
ous countries  and  climates  of  the  earth.  But  on 
this  subject  w^e  can  only  expect  an  approximation 
to  accuracy.  The  science  of  medical  statistics  is  far 
from  being  advanced  in  any  country ;  and  in  our  own, 
especially,  it  has  been  attended  to  but  very  little. 
Our  bills  of  mortality  not  being  ordinarily  kept 
by  those  competent  to  the  task,  are  apt  to  be  loose 
and  inaccurate,  and  the  names  of  different  diseases 
are  frequently  confounded  with  each  other.  Any 
data,  therefore,  from  this  source,  are  too  uncertain 
for  accurate  philosophical  deductions.  It  should  be 
observed,  too,  that  the  term  consumption  is  em- 
ployed by  many  in  a  sense  too  vague  and  extended, 
being  allowed  to  embrace,  not  only  affections  of  the 
lungs  very  different  in  their  nature,  but  sometimes 
even  diseases  of  other  parts,  under  which  the  indi- 
vidual gradually  wastes  away  and  dies ;  whereas  — 
3 


18  RELATIVE    MORTALITV. 

as  I  shall  soon   show — it   ought  to  be  limited    to 
one  peculiar  affection  of  the  organs  of  respiration. 

Dr  Sydenham  said  that  two  thirds  of  those  who 
died  of  chronic  diseases,  in  Great  Britain,  fell  vic- 
tims to  consumption.  The  estimates  of  Drs  Heber- 
den.  Young  and  Woolcombe,  show  us  that  an 
average  of  about  one  in  four  of  the  deaths  which 
happen  in  Great  Britain,  are  from  the  disease  I  am 
describing.  It  is  a  curious  fact  that  in  Bristol  there 
is  the  greatest  relative  amount  of  mortality  from  con- 
sumption—  and  among  its  native  inhabitants — of 
any  place  yet  compared  with  it ;  although  this  town 
is  in  the  southern  part  of  England,  and  is  a  great 
resort  for  consumptive  individuals. 

Laennec  states  that  in  Paris,  and  the  great  cities 
in  the  interior  of  France,  the  proportion  of  deaths 
from  consumption  is  well  known  to  be  one  in  four 
or  five. 

In  the  United  States  of  America,  the  ratio  of 
deaths  from  the  disease  will  of  course  vary  accord- 
ing to  latitude — being  greatest  in  the  Northern  and 
Middle  States.  In  Boston,  the  average  of  deaths 
by  it,  compared  with  other  diseases,  may  be  about 
one  in  from  four  to  five.  In  New  York,  the  pro- 
portion will  probably  vary  but  little  from  this.  In 
Philadelphia,  it  may  be  about  one  in  five.  And  as 
we  advance  south,  hepatic  diseases  and  fevers  in- 
crease, and  consumption  gradually  diminishes. 


19 


CHAPTER  II. 

fJENERAI.    VlliW    OF    THi:    LUNGS    AND    THEIR    FUNCTrONS. 

As  the  disease  under  consideration  has  its  loca- 
tion in  the  lungs,  and  as  some  of  my  readers  may 
be  unacquainted  with  human  physiology,  I  trust  it 
will  not  be  deemed  irrelevant  if  I  introduce  here  a 
very  general  and  concise  account  of  these  organs 
and  their  function. 

Anatomical  description.  —  The  lungs  or  lights,  in 
company  with  the  heart  and  large  blood-vessels,  to 
which  they  form  an  important  appendage,  are  in- 
closed in  a  distinct  cavity,  familiarly  known  as  the 
thorax,  or  chest.  It  is  formed  by  the  sternum  or 
breast-bone,  the  ribs  and  their  muscles,  the  spine, 
and  at  the  inferior  part  by  a  large  flat  muscle,  called 
the  diaphragm  or  midriff,  which  forms  a  sort  of 
floor  for  the  thoracic  cavity,  and  separates  it  from 
that  of  the  abdomen,  immediately  below,  and  which 
contains  the  stomach,  liver,  intestines,  &c.  —  organs 
immediately  subservient  to  the  functions  of  digestion 
and  assimilation.  The  great  organs,  therefore,  of 
respiration  and  circulation,  have  no  direct  connexion 
with  those  of  digestion,  and  the  functions  immediate- 
ly associated  with  it. 

There  are  two  lungs,  a  right  and  a  left,  separated 
by  a  vertical,   membranous  partition,  passing  from 


20  THE    LUNGS, 

the  sternum  to  the  hack-bone,  and  (liviclin^  the 
chest  into  two  nearly  equal  cavities.  The  right 
lung  is  a  little  larger  than  the  left,  possessing  three 
lobes,  while  the  latter  has  but  two. 

The  ibrm  oithe  lungs  is  conical,  their  base  rest- 
ing, as  it  were,  on  the  diaphragm,  and  their  apex 
in  contact  with  the  most  elevated  part  of  the  thorax. 
They  are  remarkably  light  and  spongy ;  their  tex- 
ture is  extremely  delicate;  and  so  compressible  are 
they  that,  though  in  their  natural  condition  com- 
pletely filling  the  chest,  they  are  capable  of  being 
so  reduced  as  to  occupy  only  a  space  of  two  or  three 
square  inches. 

They  are  composed  essentially  of  elastic* air- 
tubes,  very  delicate  membranous  air-cells,  blood- 
vessels, and  are  externally  invested  by  a  strong, 
shining  membrane,  which  is  reflected  from  them  over 
the  interior  of  the  thorax,  forming  for  it  a  complete 
lining;  it  is  called  the  pleura,  and  is  the  membrane 
which  is  inflamed  in  the  disease  termed  pleurisy. 

In  the  natural  condition  of  the  lungs,  their  exter- 
nal surface,  or  investing  pleura,  is  in  contact  with, 
but  does  not  adhere  to,  the  pleura  lining  the  tho- 
rax ;  yet,  as  slight  inflammation  readily  occasions 
such  adhesion,  it  very  commonly  exists  to  a  greater 
or  less  extent ;  but  unless  extensive,  does  not  seem 
materially  to  impede  respiration. 

I  may  describe  the  lungs  as  reared  up  in  the  fol- 
lowing manner.  An  elastic  air-tube,  called  the 
trachea  or  windpipe,  opens  into  the  superior  por- 
tion of  the  throat — and  consequently  communicates 


AND    THEIR    FUNCTION, 


21 


with  the  mouth  and  posterior  part  of  the  nostrils — 
by  a  curious  mechanism,  in  which  the  voice  is  mostly 
formed,  called  the  larynx.  This  tube  passes  down 
the  neck,  enters  the  chest,  and  then  forks  into  two 
divisions  called  bronchia  or  bronchi^  from  a  Greek 
word  meaning  the  throat,  one  going  to  each  lung. 
They  then  subdivide,  and  go  on  ramifying  again  and 
again,  becoming  smaller  and  smaller,  and  less  and 
less  elastic,  until  they  ultimately  terminate  in  the 
minute  vesicles  or  air-cells  to  which  I  have  before 
alluded.  These  air-cells,  w^ith  the  air-tubes  con- 
ducting to  them,  may  be  viewed  as  the  frame  work 
of  the  lungs,  and  constitute  the  greater  proportion 
of  their  substance.  The  cells,  too,  always  contain- 
ing more  or  less  air,  it  is  to  them  that  these  organs 
owe  their  light  and  spongy  character. 

The  union  of  these  little  vesicles  is  effected 
through  the  medium  of  a  fine  membrane  denomin- 
ated cellular,  which,  though  so  abundant  in  many 
other  structures  of  the  body,  is  here  very  small  in 
quantity.  Every  where  upon  these  cells,  minute 
vessels  are  ramifying,  to  carry  to  them  blood  to  be 
acted  upon  by  the  vital  air  they  are  continually  re- 
ceiving, and  to  convey  it  back  again  in  its  course 
to  the  heart,  after  having  undergone  its  mysterious 
aerial  change. 

It  appears  to  have  been  a  grand  principle  of  na- 
ture in  building  up  the  beautiful  and  important 
organs  of  respiration,  to  provide  that  the  greatest 
possible  quantity  of  blood  should  be  brought  under 
the  influence  of  the  greatest  possible  amount  of  air. 


22  THE    LUNGS, 

The  number  of  the  air-cells  exceetls  all  accurate 
calculation.  They  have  been  estimated  in  man  at 
between  one  and  two  hundred  millions,  and  as  pre- 
senting a  surface  of  fifteen  hundred  square  feet. 
They  exercise,  too,  as  may  readily  be  conceived, 
the  most  important  agency  in  the  breathing  function, 
since  it  is  during  the  passage  of  the  blood  over  their 
delicate  coats  that  the  essential  vital  influence  is 
wrought  upon  this  fluid. 

Physiology  of  the  function  of  respiration.  —  The 
diaphragm,  in  its  relaxed  and  natural  state,  ascends 
upward  into  the  chest  in  the  form  of  an  arch.  When 
respiration  is  to  be  effected,  its  centre,  which  is 
tendinous,  is  drawn  down  by  the  contraction  of  the 
flat  muscle  attached  to,  and  encircling  it,  and  the 
whole  midriff"  is  thus  brought  into  the  form  of  a 
plane,  and  the  cavity  of  the  thorax  consequently 
becomes  enlarged.  The  ribs,  likewise,  which  form 
almost  the  entire  walls  of  the  chest,  hanging  in 
their  natural  state,  obliquely  to  the  spine,  or  from 
above  downward,  are  elevated  by  the  contraction  of 
their  muscles,  augmenting  still  more  the  capacity  of 
the  thorax.  The  lungs,  and  air-tubes  conducting  to 
them,  are  but  passive  agents  in  the  function.  Bear- 
ing in  mind  now,  that  the  air  is  an  elastic  fluid, 
ever  tending  to  an  equilibrium,  and  that  more  or 
less  of  it  is  always  contained  within  the  air-cells,  it 
will  easily  be  conceived  that  as  the  thoracic  cavity 
enlarges,  this  residuary  air  must  expand  to  avoid 
the  vacuum  which  would  otherwise  take  place  be- 
tween the  exterior  surface  of  the  lungs  and  the  in- 


AND    THEIR    FUNCTION.  23 

terior  surface  of  the  thorax ;  and  the  next  and  neces- 
sary consequence  is,  that  the  denser  air  from  without 
must  rush  into  the  mouth  or  nostrils,  one  or  both, 
and  through  the  windpipe  into  the  lungs,  to  restore 
the  balance  between  it  and  the  rarefied  air  within. 
It  is  literally  a  mechanical  action,  on  the  principle 
of  suction,  and  may  be  nearly  imitated  by  closing 
the  valve  of  the  common  bellows,  and  drawing  air 
through  its  nose  by  enlarging  its  cavity. 

Ordinary  expiration  is  almost  a  passive  act ;  it  is 
a  restoration  of  the  active  agents  of  respiration  to 
their  natural  or  relaxed  condition,  and  depends  in 
a  great  measure  on  theit*  physical  properties,  espe- 
cially the  elasticity  of  their  cartilages.  Hence  it  is 
the  last  act  of  the  dying,  and  they  are  said  to  ex- 
pire. 

In  placid  breathing,  as  in  healthy  young  children 
when  at  rest,  there-  is  but  slight,  if  any  motion  of 
the  ribs,  the  diaphragm  alone  acting.  Hence  we 
see  how  ordinary  respiration  may  be  maintained 
when  the  thorax  is  so  confined  by  dress  that  all  mo- 
tion of  the  ribs  must  cease.  If,  however,  under 
such  restraint,  extraordinary  physical  exertions,  or 
strong  moral  emotions  increase  the  demand  for  air, 
and  consequently  for  extended  and  rapid  motions  of 
the  ribs,  a  sense  of  suffocation  is  immediately  expe- 
rienced, and  fainting  and  even  death  may  ensue, 
unless  free  play  is  speedily  given  to  the  ribs,  by 
taking  away  the  mechanical  obstruction  which  im- 
pedes their  motions.  Thus  it  is  that  we  often  loosen 
our  garments  when  under  the  influence  of  severe 


24  THE    LUXGS, 

• 

exercise  or  strong;  passion,  and  that  persons  afflicted 
with  diseases  of  the  heart  or  lungs,  or  any  which 
much  affect  the  respiration,  suffer  great  distress 
from  the  inllucnce  of  a  tight .  dress,  or  any  cause 
which  restrains  the  thoracic  motions. 

From  the  increased  ossific  depositions  in  the  ad- 
vance of  life,  the  ribs  become  less  movable,  which 
is  probably  one  reason  why  old  persons  are  apt  to 
breathe  with  embarrassment  on  exercise. 

It  may  be  readily  understood,  too,  how  the  habit 
of  exercise,  calling  for  increased  motions  of  the  ribs, 
may  tend  to  maintain,  and  even  augment  their  facil- 
ity of  action,  and  may  tlfus  add  to  the  vigor  of 
respiration,  as  well  as  of  all  the  other  important 
functions  of  the  body. 

Habitual  tranquillity  of  respiration,  with  strong 
capabilities  in  reserve  for  extraordinary  exertions, 
indicate,  on  a  general  principle,  health  and  bodily 
vigor.  Broad  shoulders  and  a  well  developed  chest 
have  ever  been  associated  with  physical  strength ; 
and  in  all  the  masterpieces  of  sculpture,  a  large 
thorax  and  great  muscular  development  are  united. 
Wide  shoulders  and  narrow  hips  constitute  the  beau 
ideal  of  the  manly  form,  in  which  we  admire  the 
indications  of  strength;  but  in  woman,  whom  we 
love  for  her  delicacy,  weakness,  and  dependence  on 
our  own  power,  the  contrary  conformation  is  wit- 
nessed, and  is  most  pleasing  to  us. 

The  inferior  animals,  in  like  manner,  display 
strength  and  activity  in  proportion  to  the  relative 
size  of  their  respiratory  organs.     Birds  are  endowed 


AND    THEIR    FUNCTION.  25 

with  a  remarkably  extensive  breathing  apparatus, 
and  their  astonishing  physical  power  is  amply 
evinced  by  their  rapid  and  long  continued  flights. 

That  light,  elastic,  invisible  fluid,  called  the  at- 
mosphere, which  encompasses  our  globe,  is  the 
essential  agent  by  which  the  vital  change  is  wrought 
in  the  blood  during  its  passage  through  the  lungs. 
It  is  composed  of  twenty  or  twenty-one  parts  or 
volumes  of  oxygen,  and  seventy-nine  or  eighty  of 
azote  or  nitrogen ;  which  relative  proportion  holds 
constant,  whether  the  air  analyzed  be  taken  from 
the  deep  valley,  or  the  lofty  mountain — from  the 
foul  lazar-house,  or  the  open  fields  of  the  country. 
Unhealthy  or  impure  air,  then,  owes  its  character 
not,  as  was  formerly  imagined,  to  a  deficiency  of 
its  oxygen,  or  a  change  of  relation  between  its  con- 
stituent elements,  but  to  noxious  effluvia  or  gases, 
which  may  be  derived  fi'om  various  sources. 

The  atmosphere  on  the  surface  of  the  earth  is,  I 
believe,  never  found  entirely  pui-e — that  is,  com- 
prising only  oxygen  and  azote.  It  has  always 
combined  with  it  a  minute  though  variable  quantity 
of  carbonic  acid  or  fixed  air ;  also  watery  vapor, 
varying  in  amount  in  different  locations  and  under 
different  circumstances.  The  aroma  of  plants  and 
their  flowers,  and  the  numerous  gases  and  volatile 
particles  given  off"  during  respiration,  and  the  decay 
of  animal  and  vegetable  substances,  are  in  like 
manner  often  blended  with  it.  Some  of  these  are 
necessary,  as  a  certain  amount  of  water  in  solution ; 
and  those  pleasing  odors  exhaled  from  many  iamilies 
4 


26  TJIE    J.UNGS, 

of  ihe  vegetable  kin,ij;dom,  beside  the  enjoyment 
they  impart,  may  exercise  a  healthful  influence  on 
our  constitutions.  Others,  however,  as  the  subtile 
effluvia  and  gases  arising  from  decomposing  organ- 
ized matter,  are  extremely  pernicious  to  human 
life,  and  are  probably  a  source  of  many  of  the  mal- 
adies from  which  we  suffer. 

The  air,  too,  differs  in  the  interior  and  on  the 
sea-coast,  in  towns  and  in  the  country.  It  is  denser 
and  contains  more  impurities  in  valleys  than  on 
hills.  It  is  likewise  unquestionably  affected,  though 
insensibly,  by  the  character  of  the  soil ;  which  in- 
fluence, however,  can  only  be  inferred  ffom  effects 
on  the  human  constitution.  The  night  air  is  less 
wholesome  than  that  of  the  day. 

The  fact  is  well  known  that  diseases  are  often 
materially  benefitted  by  simple  changes  of  air,  in- 
dependent too  of  any  remarkable  discrepance  of 
temperature.  Analytic  chemistry,  however,  is  not 
yet  sufl^ciently  advanced  to  acquaint  us  with  those 
various  modifications  of  the  atmosphere  which  so 
essentially  influence  the  human  body,  both  in  its 
healthy  and  morbid  states. 

The  precise  nature  of  the  agency  exercised  by 
the  air  on  the  blood  is  not  understood.  The  func- 
tion of  respiration  appears  to  exist  on  the  borders 
of  chemistry  and  vitality,  and  is  more  or  less  influ- 
enced by  the  laws  of  each. 

The  air  that  is  expired  is  discovered  to  have 
experienced  a  material  alteration  in  its  chemical 
composition.     A  portion  of  its  oxygen  has  disap- 


AND    THEIR    FUNCTION.  27 

peared,  its  carbonic  acid  is  increased,  and  the  sum 
of  its  azote  remains  about  the  same.  And  by 
continuing  to  breathe  the  same  air,  nearly  all  the 
oxygen  will  vanish,  the  carbonic  acid  will  be  still 
further  augmented,  while  the  amount  of  nitrogen  is 
but  slightly  altered.     ' 

It  was  long  believed  that  oxygen  was  actually 
absorbed  into  the  blood,  and  that  by  such  union  the 
vivityiiig  powers  ^  this  fluid  were  renewed.  This 
theory  not  being  found  tenable,  another  was  sub- 
stituted— viz.  that  the  oxygen,'  instead  of  being 
retained  in  the  blood,  merely  united  with  and 
carried  oif  its  impurities,  thus  restoring  its  neces- 
sary integrity.  The  deleterious  agent  acquired 
during  the  circulation,  was  supposed  to  be  carbon ; 
and  the  oxygen  of  the  atmosphere  having  a  strong 
affinity  for  this  principle,  was  thought  to  combine 
with  it  chemically,  forming  the  expired  carbonic 
acid.  Other  theories  have  also  been  advanced  on 
the  subject,  yet  none  satisfactorily  account  for  all 
the  phenomena  of  respiration. 

The  oxygen  of  the  atmosphere  is  proved  to  be  the 
essential  principle  through  whose  instrumentality 
the  life-giving  power  of  the  blood  is  restored ;  and 
not  unlikely,  it  may  act  by  uniting  with  and  con- 
veying away  something,  which,  if  retained,  would 
prove  fatal  to  the  animal  economy.  It  is  not  im- 
probable, moreover,  that  a  portion  of  it  may  actually 
be  absorbed ;  and  some  experiments  have  gone  to 
show  that  a  minute  quantity  of  azote  disappears 
during  respiration. 


28  PATHOLOGY    OF    CONSUMPTION. 

Oxygen,  though  so  essential  to  vital  existence,  is 
too  stimulating  to  be  breathed  in  its  unmixed  state, 
and  would  soon  destroy  lile  were  it  not,  as  in  the 
atmosphere,  largely  diluted  with  nitrogen.  No 
other  combination  of  it,  except  what  nature  has 
prepared  for  us,  is  capable  of  supporting  vitality  for 
any  considerable  time. 

It  has  been  estimated  that  an  adult  will  consume 
about  forty-five  thousand  cubic  inches  of  oxygen  in  a 
day ;  but  it  is  plain  the  amount  must  be  greatly  in- 
fluenced by  circumstances,  as  diet,  exercise,  moral 
feelings,  &c.  The  more  ample  the  chest,  and 
active  the  circulation,  the  larger  will  be  the  quan- 
tity consumed ;  and  other  things  being  equal,  the 
greater  will  be  the  bodily  vigor. 


CHAPTER  III. 

BRIEF    VIEW    OF    THE   PATHOLOGY  OF  CONSUMPTION,   OR  THE    DIS- 
EASED   CHANGE    WHICH    TAKES    PLACE   IN     THE     LUNGS. 

Since  the  publication  of  Laennec's  philosophical 
work  on  the  chest,  in  1819,  the  term  phthisis  pul- 
monalis,  or  consumption,  has  been  very  properly 
restricted  to  a  condition  of  the  lungs  in  which  there 
exist  certain  morbid  productions,  soon  to  be  de- 
scribed, denominated  tubercles.  Previous  to  this 
period,  a  wider  latitude  was  given  to  the  disease, 
it  being  allowed  to  comprehend  several  affections 


PATHOLOGY  OF  CONSUMPTION.         29 

of  the  lungs,  distinct  in  their  nature,  varying  in 
their  degree  of  fatality,  and  requiring  different  forms 
of  management ;  the  obvious  tendency  of  which  was 
to  retard  the  philosophic  knowledge  of  the  com- 
plaint, and  consequently  lead  to  error,  both  in  pre- 
diction and  treatment. 

An  individual,  for  example,  may  be  afflicted  for 
months  or  years  W'ith  a  chronic  cough  and  expecto- 
ration, ultimately,  however,  subsiding  and  leaving 
him  in  health.  Or  it  may  continue,  with  remissions 
perhaps,  through  life;  the  subject  dying  of  some 
other  disease.  Or,  lastly,  it  may  result  in  emacia- 
tion, hectic  fever,  night  sweats,  with  many  other 
of  the  symptoms  of  consumption,  and  ultimately 
terminate  in  death,  and  yet  not  be  this  disease,  but 
chronic  inflammation  of  the  mucous  or  lining  mem- 
brane of  the  air-tubes,  know^n  by  the  various  names 
of  chronic  bronchitis,  chronic  pulmonary  catarrh, 
and  cold  on  the  lungs.  The  intemperate  in  the  use 
of  spirituous  liquors,  and  old  men,  are  often  its 
subjects,  though  it  is  not  confined  to  such.  It  is 
aggravated  by  cold,  damp  weather,  by  irritating 
substances  inhaled  into  the  lungs,  and  by  all  undue 
excitements.  It  not  unfrequently  yields,  even  when 
it  has  been  of  long  duration,  to  the  influence  of  sea 
voyages,  journeys,  and  mild  climates;  and  hence 
may  constitute  many  of  those  cases  reported  as 
declared  consumption,  which  have  recovered  under 
the  use  of  such  means.  The  most  careful  exam- 
ination on  the  part  of  the  physician  is  often  demanded 
to  distinguish  it  from  genuine  consumption,  and  the 


30  PATIIOT.Of.V    OF    CONSUMPTION. 

diseases  may  in  some  instances  be  confounded  even 
by  the  most  experienced  and  judicious  in  our  pro- 
fession. 

Tubercle,  derived  from  the  Latin  word  tuher- 
culum,  meaning  a  little  excrescence,  tumour  or 
swelling,  is  used  in  the  technical  language  of  med- 
icine to  designate  a  peculiar  morbid  production  of 
the  following  description.  At  first,  or  in  the  stage 
in  which  tubercles  are  usually  first  recognised — for 
some  have  described  a  prior  stage — they  are  insu- 
lated, of  a  light  yellowish  color,  opaque,  friable, 
and  resemble  cheese  in  their  appearance  and 
consistence.  They  vary  in  size,  the  largest  often 
surpassing  that  of  a  common  chestnut,  and  Andral 
tells  us  they  even  approach  the  bulk  of  an  ordinary 
orange — this,  however,  is  certainly  rare  when  they 
are  single — whereas,  the  smallest  which  are  dis- 
coverable may  not  exceed  in  size  the  head  of  a  pin. 
Their  form  in  the  lungs  is  usually  round  or  roundish, 
which  Dr  Carswell  considers  accidental,  and  owing 
to  the  equal  opposition  oifered  on  all  sides  to  their 
development.  In  this  stage  they  are  called  crude, 
or  immature. 

Tubercles,  when  formed,  commonly  go  on  aug- 
menting in  size,  more  or  less  rapidly,  according  to 
varying  influences,  their  consistence  also  diminish- 
ing, till  they  are  converted  into  a  fluid  mass, 
resembling  common  pus,  or  unstrained  whey,  and 
sometimes  stained  with  blood,  or  a  black  matter 
formed  in  the  lungs.  This  is  the  stage  of  matura- 
tion, or  softening.     The  fluid  mass  now  soon  finds 


PATHOLOGY  OF  CONSUMPTION.         31 

its  way  into  the  air-passages,  and  is  discharged  by 
expectoration,  leaving  an  ulcerous  excavation  which 
may  extend  more  or  less  rapidly,  or  remain  nearly 
stationary  for  an  indefinite  time,  continuing  to  pour 
out  tuberculous  matter,  and  in  some  rare  instances 
what  has  been  regarded  a  healing  process  may 
ensue ;  that  is,  the  walls  of  the  tubercle  contract, 
leaving  a  whitish,  puckered  cicatrice.  It  is  this 
softening  of  tuberculous  matter  that  in  common  lan- 
guage is  termed  ulceration  of  the  lungs. 

It  is  probably  a  very  rare  circumstance  that  a 
single  tubercle  only  exists  in  the  lungs ;  in  such  a 
case  the  symptoms  produced  would  be  very  slight. 
In  ordinary  cases,  the  tubercles  are  more  or  less 
numerous,  forming  groups,  and  as  they  grow  in 
size,  extend  toward  each  other,  and  often  become 
blended  into  one  mass,  and  may  discharge  their 
matter  into  the  air-passages  by  a  common  ulcerous 
opening.  Hence  may  be  explained  those  large 
ulcerous  excavations  which  are  often  found  in  the 
lungs  of  persons  who  have  died  of  consumption. 

Tubercles  may  be  more  or  less  numerous,  and 
advance  with  greater  or  less  rapidity,  rendering  the 
case  more  severe,  and  swifter  in  its  course.  In 
some  instances,  the  greater  portion  of  both  lungs  is 
found  apparently  converted  into  tuberculous  matter 
in  different  stages  of  its  progress.  And  where  the 
predisposition  is  strong,  there  is  sometimes  an  actual 
infiltration  of  a  cheesy  or  tuberculous  matter  into 
the  cellular  structure  of  the  lungs.  So  little  of  the 
sound   lungs  is  at  times  found  remaining,  that  we 


32         PATHOLOGY  OF  CONSUMPTION. 

marvel  how  life  could  have  been  maintained  under 
such  abridgment  of  the  breathing  function.  It 
proves,  however,  the  astonishing  power  possessed 
by  the  animal  constitution  of  adapting  itself  to  cir- 
cumstances when  they  are  gradually  induced. 

Tubercles,  with  rare  exceptions,  are  first  devel- 
oped at  the  superior,  and  usually  posterior,  part  of 
the  lungs.  Hence,  when  they  have  extended 
throughout  the  organs,  they  will  almost  always  be 
found  larger  and  more  advanced  at  their  summit 
than  at  their  base. 

Laennec  believed  that  tubercles,  in  the  greater 
proportion  of  cases,  appear  first  in  the  right  lung. 
The  observations,  however,  of  Louis,  and  of  most 
other  eminent  pathologists,  go  to  show  that  the  left 
lung  is  the  more  frequent  seat  of  tubercles  than 
the  right. 

Tubercles  may  remain  in  their  crude  or  immature 
state  from  a  few  weeks  to  a  number  of  years,  before 
undergoing  the  process  of  maturation ;  or,  at  least, 
there  is  much  reason  for  believing  this,  though  it  is 
not  susceptible  of  positive  demonstration.  Many 
times  the  symptoms  do  not  distinctly  proclaim  them- 
selves until  the  stage  of  softening  has  commenced 
in  one  or  more  of  the  tubercles. 

In  many  cases,  as  happens  in  common  abscess,  a 
cyst  is  formed  to  insulate  the  tuberculous  matter 
from  the  sound  portion  of  the  lung,  inclosing  it,  as 
it  were,  in  a  bag. 

In  some  rare  instances,  a  tubercle,  instead  of 
suppurating  or  softening,  undergoes   a  cretaceous 


PATHOLOGY    OF    CONSUMPTION.  33 

transformation,  or  becomes  a  hard  and  gritty  mass, 
containing  an  unusual  quantity  of  phosphate  of  lime, 
and  not  unfrequently  resembling  dry  putty.  In  this 
condition  it  may  lie  dormant,  or  produce  but  slight 
irritation,  and  hence  this  change  has  been  regarded 
as  one  of  nature's  attempts  at  a  cure,  and  in  which 
she  partially  succeeds. 

The  eruption  of  tubercles  is  commonly  consecu- 
tive, and  the  first  is  seldom  so  abundant  as  to  prove 
fatal ;  hence  may  be  explained  the  remissions,  and 
even  intermissions,  so  often  noticed  in  the  disease. 

In  the  victims  of  consumption,  tubercles  are  not 
usually  confined  to  the  lungs  alone;  but,  there 
existing  for  the  most  part  a  general  tuberculous 
disposition,  they  may  be  developed  in  any  organ 
or  structure  of  the  body;  and  in  proportion  to 
the  intenseness  of  the  constitutional  taint  will  gen- 
erally be  their  diffusion  throughout  the  system. 
Thus  tubercles  occur  in  the  larynx,  affecting  the 
voice  and  deglutition;  in  the  bowels,  liver,  kidneys, 
&LC.,  and  in  some  cases  even  in  the  brain  and 
heart;  and  rarely,  in  some  of  the  instruments  of 
locomotion,  as  the  muscles,  &-c. 

These  morbid  productions  are  not  peculiar  to  our 
o\\n  species.  The  monkey  family,  when  removed 
from  their  native  tropical  climes  to  colder  regions, 
and  kept  in  an  unnatural  state  of  confinement,  very 
frequently  die  tuberculous.  In  menageries,  these 
animals  are  often  afflicted  with  a  cough,  and  not 
uncommonly  die  manifesting  all  the  symptoms  of 
5 


34         PATHOLOGY  OF  CONSUMPTION. 

consumption,  and  their  lungs,  as  well   as  various 
other  organs,  are  found  fdled  with  tubercles. 

They  have  been  Ibund,  also,  in  other  tropical 
animals  dying  in  menageries — in  the  lion,  for  in- 
stance; and  among  birds,  the  parrot  often  becomes 
their  victim.  They  happen,  likewise,  to  many  of 
our  domestic  animals,  as  the  horse,  ox,  cow,  sheep, 
hog,  rabbit,  and  other  of  the  mammalia.  The  dog 
is  very  rarely  affected  by  them. 

"All  the  milch  cows  in  Paris,  and  no  doubt  else- 
where, become  tuberculous  after  a  certain  period  of 
confinement.  I  have  been  informed  that  for  some 
time  after  the  disease  has  commenced^  the  quantity 
of  milk  obtained  is  greater  than  before,  and  that 
their  flesh  is  more  esteemed  by  the  unsuspecting 
epicure  than  that  of  the  healthy  animal.  A  circum- 
stance of  the  same  kind  is  mentioned  by  Aristotle, 
who  observed  tubercles  in  the  pig,  the  ox,  and  the 
ass ;  in  regard  to  strumous  pigs,  he  says,  that 
when  the  disease  (grandines)  exists  in  a  slight 
degree,  the  flesh  is  sweeter."* 

Tubercles  have  also  been  found  in  our  domestic 
birds,  as  the  turkey  and  fowl.  They  have  likewise 
been  discovered  in  reptiles ;  and  some  recent  obser- 
vations have  detected  something  resembling  tuber- 
culous matter  even  in  insects. 

M.  Andral  tells  us  that  most  of  the  animals  in 
whom  he  has  proved  the  existence  of  tubercles,  are 
either  those  transported  from  a  hot  to  a  cold  climate, 
where  they  are  deprived  of  their  liberty  and  exer- 

*A  Treatise  on  Pulmonary  Consumption,  by  James  Clark,  M.  D.,  p.  167. 


PHYSICAL    SIGNS,    ETC.  35 

cise,  as  in  the  instance  of  monkeys  and  parrots,  or 
else  confined  in  damp  situations,  without  sun,  and 
almost  without  air,  as  cows,  pigs  and  house  rabbits, 
or  exposed  to  constant  alternations  of  heat  and  cold, 
or  to  constrained  and  violent  exercise,  as  is  the 
case  with  the  horse.  We  shall  see,  hereafter,  that 
like  circumstances  tend  to  originate  tubercles  in 
the  human  subject. 


CHAPTER  IV. 

PHYSICAL    CHARACTERS     INDICATING    A    PREDISPOSITION    TO    CON- 
SUMPTION  RELATIVE   PREVALENCE    OF    THE    DISEASE    IN    THE 

TWO    SEXES PERIODS     OF     LIFE     DURING    WHICH    IT    IS    MOST 

FREQUENT. 

Physical  signs.  —  It  is  a  matter  of  common  obser- 
vation, that  a  tendency  to  consumption,  or  the 
development  of  tubercles  in  the  lungs,  is  frequently 
associated  with  striking  peculiarities  of  physical  con- 
stitution. The  same  traits,  likewise,  indicate  what 
we  denominate  a  scrofulous  or  strumous  habit.  In 
truth,  there  appears  to  exist  a  close  relationship 
between  scrofula  and  tubercles,  and  not  unlikely 
they  are  but  a  modification  of  one  and  the  same 
morbid  condition.  Hence  the  terms  scrofulous  and 
tuberculous  are  not  unfrequently  employed  to 
express  an  identical  diseased  tendency,  and  may 
often  be  so  used  in  the  present  treatise. 

But  I  will  proceed  to  delineate  these  constitutional 


36  PHYSICAL    SIGNS 

marks,  some  of  which  have  been  noticed  since  the 
earliest  days  of  medical  science.  A  fair,  delicate 
skin,  often  of  a  waxy  whiteness  and  clearness, 
approaching^  to  semi-transparency,  and  looking  as 
though  it  had  been  blanched.  A  bright  redness  of 
the  cheeks,  more  especially  on  their  prominences,  is 
not  uncommonly  displayed  in  such  subjects,  and 
contrasts  strongly  with  the  soft  paleness  in  its 
vicinity.  This  red  tint  often  appears  as  though  it 
had  been  laid  on  with  a  brush.  When  absent  it  is 
very  readily  induced,  as  well  as  general  flushing  of 
the  face,  from  the  influence  of  trifling  excitements, 
whether  moral  or  physical ;  hence  there  may  be 
observed  frequent  transitions  of  color,  the  counte- 
nance now  being  lighted  up  with  a  blooming  red, 
which  in  a  little  while  fades  into  a  sickly  whiteness. 
Such  complexions  are  generally  esteemed  handsome, 
but  to  the  experienced  eye,  it  is  a  beauty  fraught 
with  the  mournful  associations  of  its  transitory 
nature. 

The  upper  lip  of  such  individuals  is  apt  to  be 
tumid;  their  teeth  are  often  large,  of  a  pearly 
whiteness,  and  sometimes  brittle,  and  very  subject 
to  decay.  The  eyes  are  light,  retaining  the  pecu- 
liar blue  tint  of  infancy,  and  their  white  has  a  dull 
pearly  appearance.  In  some,  the  pupil  of  the  eye 
seems  enlarged.  The  hair  is  flaxen,  fine  and  thin; 
the  muscles  and  skin  soft;  the  limbs  round  and 
smooth ;  the  whole  organization  seeming  as  though 
but  imperfectly  evolved,  many  of  the  characters  of 
childhood  continuing  to  mark  even  adult  age ;  or 


OF    THE    PREDISPOSITION.  37 

the  male  assimilating  to  the  delicacy  of  tissue  and 
conformation  of  the  female.  There  is  but  feeble 
energy  of  the  circulation,  particularly  in  the  extreme 
vessels;  and  the  blood  even — from  a  deficiency  in 
its  fibrin  and  red  globules — has  been  remarked  to 
be  thinner  and  more  watery  that  natural. 

The  skin  rarely  executes  well  its  functions. 
Sometimes  it  is  unnaturally  dry;  at  others,  the 
perspiration  is  too  abundant.  Some  are  liable  to 
partial  sweats,  especially  of  the  extremities.  The 
skin,  mucous  or  lining  membranes  of  the  internal 
organs,  and  lymphatic  glands,  are  very  subject  to 
become  diseased,  their  affections  usually  being  of  a 
chronic  character^  and  at  times  terminating  in  pecu- 
liar abscesses  and  ulcers,  which  are  very  tardy  in 
healing,  often  remaining  nearly  stationary  for  weeks 
or  even  months.  Such  are  called  scrofulous  ab- 
scesses and  ulcers,  and  always  indicate  a  tainted 
constitution.  Soft  swellings  of  the  lymphatic  glands 
about  the  neck  are  very  common  in  early  life, 
remaining  for  a  long  period,  or  in  some  instances, 
running  on  to  suppuration.  They  are  usually 
aggravated  by  cold,  and  relieved  during  the  warm 
season. 

To  the  physical  signs  mentioned,  others  are  often 
added,  as  slender,  and  —  owing  perhaps  to  weak- 
ness or  softness  of  the  bones  in  early  life,  —  not 
unfrequently,  ill-shaped  lower  extremities.  The 
chest,  too,  is,  for  the  most  part,  relatively  small. 
It  may  be  wide,  yet  very  thin,  when  measured  from 
the  sternum  to  the  spine,  so  that  broad  shoulders. 


38  PHYSICAL    SIGNS 

though  they  commonly,  still  do  not  necessarily  indi- 
cate a  spacious  thorax.  Sometimes  the  chest  looks 
as  thougli  it  had  been  laterally  compressed,  and  the 
breast  bone  thus  projected  forward  like  that  of  a 
bird.  To  such  conformation  the  term  chicken  breasted 
is  fitly  applied. 

The  neck  of  such  subjects  is  frequently  long,  the 
shoulder  blades  stand  off  from  the  body,  and  they 
are  disposed  to  become  round  shouldered,  or  to 
allow  the  chest  to  settle  or  bend  forward,  hence 
often  exhibiting  a  remarkable  sinking  in  of  the  breast, 
and  are  termed  hollow  breasted. 

Associated  —  as  we  might  anticipate,  —  with  this 
faulty  conformation,  and  general  frailness  of  struc- 
ture, is  a  defect  of  energy  in  the  different  functions 
of  the  body.  Digestion,  circulation,  &-c.  are  feeble, 
and  readily  become  disturbed.  Severe  exertions 
soon  tire  the  muscles,  and  occasion  shortness  of 
breath,  or  panting. 

Owing  to  feebleness  of  the  vital,  and  consequently 
adjusting  powers  of  the  system,  such  persons  do  not 
bear  well  extremes  either  of  heat  or  cold.  Hence 
in  hot  weather  they  are  apt  to  experience  a  lassi- 
tude of  the  muscles,  and  a  consequent  indisposition 
to  active  exertion;  and  in  the  cold  seasons  they 
often  suffer  much,  particularly  in  the  extremities, 
from  defective  power  to  create  the  requisite  animal 
temperature.  Their  health  on  the  whole,  however, 
is  better  in  the  warm  than  in  the  cold  seasons. 
Our  damp  and  chilling  easterly  winds,  and  all  sud- 
den vicissitudes  of  weather,  are  extremely  hurtful 


OF    THE    PREDISPOSITION.  39 

to  them,  readily  exciting  catarrhal  and  other  affec- 
tions. 

If  we  lay  the  ear  upon  the  chest,  and  hearken  to 
the  respiration,  we  shall  commonly  find  it  to  be 
noisy  and  rapid,  when  compared  with  that  of  a 
healthy  individual  of  the  same  age  and  sex,  and 
placed  under  like  circumstances.  Thus  the  respi- 
ration of  the  consumptive,  even  in  adult  life,  will 
often  continue  puerile,  as  it  is  technically  termed,  or 
loud,  sonorous  and  frequent,  as  it  is  remarked  to  be 
in  children. 

It  is  a  very  common  belief  that  the  unfortunate 
subjects  of  the  consthution  described,  are  apt  to 
display,  in  union  with  amiable  and  placid  tempers, 
an  early  acuteness,  and  brilliancy  of  intellect,  and 
a  general  precocity,  which  is  too  frequently  the  sad 
harbinger  of  premature  decay.  Hence  the  lament 
so  often  heard,  that  the  most  lovely  and  promising 
of  our  race  become  the  victims  of  consumption. 
Within  the  limits  of  my  own  experience  I  can  recall 
to  memory  some  of  the  purest  and  most  interesting 
characters  who  have  fallen  early  sacrifices  to  this 
destructive  malady.  Individuals  whose  hearts  ever 
glowed  with  the  warmest  affections,  whose  feelings 
were  keenly  susceptible  to  every  virtuous  enjoyment, 
and  whose  whole  moral  nature  was  as  beautiful  as 
the  delicate  tissue  with  which  it  was  united. 

It  surely  does  seem  that  the  general  delicacy  of 
structure  of  such  constitutions,  is,  in  many  instances, 
associated  also  with  a  delicacy  of  moral  character ; 
still,  striking  exceptions  are  by  no  means  uncommon. 


40  1MI\S1(AI.    SjrJNS 

It  should  be  had  in  mind,  too,  that  wc  are  disposed 
to  regard  as  the  purest  and  best,  those  who  are 
taken  from  us  in  the  early  period  of  their  career, 
when  hope  has  raised  high  our  expectations  of  their 
promised  usefulness.  And,  moreover,  that  we  are 
always  prone  to  cherish  the  virtues  of  the  dead, 
while  we  magnify  the  faults  of  the  living.  In  the 
grave  only,  all  jealousy^  and  envy,  and  hatred 
sleep. 

This  constitution  may  be  original,  or  the  result  of 
what  are  deemed  accidental  agencies,  among  w^hich 
may  be  mentioned,  living  —  especially  during  the 
period  of  growth,  —  in  low,  cold,  damp  situations, 
deprived  of  the  genial  influence  of  the  sun's  rays. 
Under  like  circumstances,  plants  grow  up  pale, 
tender  and  watery,  bearing  but  little  resemblance 
in  external  form  and  complexion  to  similar  ones 
reared  in  the  open  air  and  sunshine.  Crowding 
together  individuals  in  ill-ventilated  places,  as  in 
manufactories  ;  poor  and  insufficient  diet,  and  vari- 
ous other  causes  presently  to  be  noted,  which 
depress  and  waste  the  energies  of  life,  or  prevent 
the  due  development  of  the  physical  organization. 

I  have  portrayed  a  combination  of  characters, 
moral  and  physical,  more  or  less  of  which  may  exist, 
and  with  greater  or  less  distinctness,  in  different 
scrofulous  or  tuberculous  constitutions.  I  would 
not,  however,  that  it  should  be  inferred,  that  every 
one  displaying  the  traits  delineated,  must  inevitably 
perish  of  consumption,  though,  under  favoring  cir- 
cumstances, such  are  always  in  great  hazard.     In 


PHYSICAL    SIGNS,    ETC.  41 

some,  however,  the  consumptive  taint  is  so  strong, 
that  they  seem  destined,  in  spite  of  all  human  means, 
to  become  the  early  victims  of  the  disease. 

Tubercles,  however,  though  very  often,  are  not 
exclusively  associated  with  the  characters  men- 
tioned. They  are  frequently  developed  in  persons 
of  quite  an  opposite  temperament,  viz.  with  black 
or  brown  hair,  black  eyes,  and  dark  complexions, 
sometimes  clear  and  handsome,  but  more  usually 
sallow  and  swarthy.  Some  of  the  most  melancholy 
instances  of  scrofula,  and  most  fatal  cases  of  con- 
sumption I  have  ever  witnessed,  have  been  in  such 
individuals.  The  temper  is  apt  to  be  more  gloomy, 
dissatisfied  and  irritable,  and  the  intellect  less  acute 
than  in  the  other  class  of  consumptive  subjects. 

Consumption,  then  —  in  oiu"  own  country,  and 
probably,  also,  in  the  northern  parts  of  Europe — is 
most  frequently  associated  with  the  first  described 
constitution  ;  quite  common,  and  often  very  fatal  in 
the  second  ;  and  it  will  at  times  declare  itself  in 
the  best  apparent  bodily  formation,  and  to  which  no 
suspicion  of  it  had  been  affixed.  No  constitution, 
no  temperament  can,  therefore,  claim  entire  exemp- 
tion from  its  invasions.  I  have  witnessed  it,  in  a 
few  instances,  in  persons  with  ample  and  well  de- 
veloped chests,  and  endowed  with  great  bodily 
vigor  and  strength  of  wind,  Dr  Clark  tells  us, 
that  several  of  the  celebrated  English  pugilists  have 
died  tuberculous. 

Relative  prevalence  of  phthisis  in  males  and  females. 
The  reports  of  the  Paris  hospitals,  which  are  on  a 
6 


42  RELATIVE    PKE\ALENCE 

very  extended  scale,  and  made  by  the  most  scien- 
tific and  accurate  medical  observers  of  France,  unite 
in  proving  a  greater  relative  mortality  from  con- 
sumption in  females  than  among  males.  Louis' 
general  inference  from  a  large  number  of  cases, 
carefully  noted  by  himself,  is,  "  ^we  h  nombre  des 
phthisiqui's  chez  ks  hommcs,  et  chez  les  femmes  dtait 
comme  70  est  a  92."* 

Dr  Clark,  in  his  work  already  quoted,  has  given 
a  table  draw^n  from  the  medico-statistical  reports  of 
different  countries,  showing  a  result  more  favorable 
to  the  females.  But  the  Doctor  himself  considers 
this  table  to  be  quite  imperfect,  and  admits  that  any 
inference  from  it  can  be  viewed"  merely  as  an  ap- 
proximation to  the  truth.  Our  own  reports  are  not 
sufficiently  extended  or  perfect,  to  shed  much  addi- 
tional light  on  the  question. 

The  females  of  cold  and  variable  climates  are, 
also,  the  more  frequent  subjects  of  scrofula  than  the 
males.  And  that  peculiar  swelling  of  the  throat 
called  goiire  or  bro?ichocelc,  which  has  been  thought 
to  bear  some  kindred  to  scrofula,  is  more  commonly 
witnessed  in  women  than  in  men.  It  prevails  in 
some  districts  of  our  own  country,  as  on  certain 
parts  of  the  Connecticut  river,  and  on  the  borders 
of  some  of  our  northern  lakes  ;  but  is  seen  on  a 
vastly  more  extended  scale  among  the  Alps,  and 
other  mountain  ranges  of  Europe,  as  the  Apennines, 
and  Pyrenees.  In  some  situations  among  the  Alps, 
goitre  is  so  common  as  to  seem  almost  a  local  char- 

*  Recherches  sur  la  Phthisic,  p.  523. 


IX    TllK    TWO    SEXES.  43 

acteristic.  But  wherever  I  have  had  opportunities 
of  observins:  the  affection  I  have  remarked  females 
to  be  its  more  frequent  subjects. 

Both  the  oroanization  and  habits  of  females  have 
been  supposed  to  afford  reasons  why  they  should  be 
the  more  liable  to  consumption.  Their  native  soft- 
ness and  delicacy  of  structure  approximate  them  to 
that  phvsical  condition  which  I  have  described  as  so 
often  united  with  a  tendency  to  scrofula  and  tuber- 
cles. Males,  as  has  already  been  said,  who  are 
predisposed  to  these  affections,  often  resemble  the 
female  in  many  of  their  constitutional  characters. 
This  dainty  organization,  too,  of  the  female  econ- 
omy, seems  inconipatible  with  that  full  energy  of 
life  which  is  needful  to  react  against  those  vicissi- 
tudes of  climate  so  operative  in  the  generation  of 
tubercles.  The  adjusting  powers  of  the  female  con- 
stitution in  relation  to  climate,  I  conceive,  on  a 
general  principle,  to  be  inferior  to  those  of  the 
male. 

Females  have  also  been  thought  to  be  more  sub- 
jected to  the  influence  of  the  exciting  causes  — 
those  tending  to  develop  the  disease  when  the 
predisposition  to  it  already  exists,  —  than  males. 
Their  physical  education  in  early  life  is  but  little 
regarded.  They  usually  exercise  less,  are  less  ex- 
posed to  the  open  air,  and  to  those  various  other 
occasions  and  circumstances  which  tend  to  elicit 
bodily  vigor,  than  our  own  sex.  From  the  fashion 
of  their  dress,  their  bust  is  more  exposed,  and  the 
necessary  motions  of  their  chest  more  impeded  than 


44  A(.;r,s   wiikn 

in  males  ;  .iTid,  perhaps,  on  a  "general  principle, 
they  clothe  less  warmly,  especially  their  feet,  than 
ourselves.  These  things  are,  at  any  rate,  worthy 
the  consideration  of  the  female  part  of  the  commu- 
nity. 

Periods  of  life  during  which  consumption  is  most 
usually  developed.  Tubercles  have  been  found  in  the 
lungs  at  almost  every  period  of  existence,  from  in- 
fancy to  decrepitude.  Laennec  discovered  them 
in  the  chest  of  a  woman  upwards  of  ninety-nine. 
Still,  all  ages  are  by  no  means  equally  obnoxious  to 
them.  Hippocrates  thought  consumption  to  be  most 
frequent  from  eighteen  to  thirty-five,  and  the  best 
modern  observations  go  to  confirm  the  accuracy  of 
this  ancient  sage. 

As  females  mature  sooner,  the  disease  is  apt  to 
be  developed  a  little  earlier  in  them  than  in  males. 
Andral  thinks  that  males  are  especially  liable  to 
pulmonary  tubercles  between  the  ages  of  twenty- 
one  and  twenty-eight,  while  females  are  more  ex- 
posed to  them  before  tw^enty.  Laennec's  observa- 
tions led  him  to  a  like  opinion  with  Hippocrates, 
viz.  that  tubercles  are  most  frequently  declared  in 
the  lungs  between  the  periods  of  eighteen  and 
thirty-five. 

The  following  tables,  showing  the  relative  pro- 
portion of  deaths  from  phthisis  after  the  age  of 
fifteen,  are  from  Louis'  work  on  this  disease,* 
already  quoted.  The  former  is  drawn  from  the 
observations  of  Louis  himself,  the  latter  from  those 

•  p.  533. 


USUALLY    DEVELOPED. 


45 


of  M.  Bayle.  They  both  unite  in  proving  the  most 
considerable  number  of  deaths  to  happen  between 
the  ages  of  twenty  and  forty. 


TABLE     FIRST. 


Age. 

From  1 5  to  20, 
"      20  to  30, 
"      30  to  40, 

Number  of  deaths. 
.      ...      11 
.     ...     39 
.     ...     33 

Age. 
From  40  to  50, 
"      50  to  60, 
"      60  to  70, 

Number  of  deaths. 
...     23 
...     12 
...       5 

TABLE    SECOND. 

Age. 

From  1 5  to  20, 
"      20  to  30, 
"      30  to  40, 

Number  of  deaths. 
.     ...     10 
.     ...     23 
.     ...     23 

Age. 

From  40  to  50, 
"      50  to  60, 
"      60  to  70, 

Number  of  deaths. 
...     21 
...     15 

...       8 

Dr  Clark  has  given  two  tables  collected  from  ob- 
servations made  in  different  cities  and  countries, 
whose  general  average  goes  to  show  that  the  great- 
est number  of  deaths  from  consumption,  happen 
between  the  ages  of  twenty  and  thirty;  next  in 
proportion,  between  thirty  and  forty,  and  then  be- 
tween forty  and  fifty.  He  observes  that  "  This 
remarkable  agreement  of  all  the  places,  warrants 
the  conclusion,  that  after  the  fifteenth  year  of  age, 
fully  one  half  the  deaths  from  consumption  occur 
between  the  twentieth  and  fortieth  years,  and  that 
the  mortality  is  about  its  maximum  at  thirty,  and 
from  that  time  gradually  diminishes."* 

Sometimes  boys  and  girls  at  about  the  age  of  pu- 
berty grow  up  with  astonishing  rapidity,  so  much 
so  that  the  whole  system  becomes  debilitated  in 
consequence  of  the  great  draft  made  upon  its  powers 


"  On  Pulmonary  Consumption,  p.  137. 


46  HEMOPTYSIS, 

to  support  this  sudden  increase  of  the  body.  Under 
such  circumstances,  if  a  predisposition  to  consump- 
tion exists,  it  will  be  occasionally  developed. 

Girls  at  this  period  —  I  mean  when  ripening  into 
puberty — if  predisposed  to  tubercles,  are  in  greater 
hazard  than  boys,  owing  to  the  difficulty  which 
their  feeble  energies  often  experience  in  establishing 
the  function  peculiar  to  the  female  constitution, 
which  is  to  be  set  up  at  this  time.  Thus  their 
health  may  become  deranged,  a  train  of  unpleasant 
symptoms,  generalized  under  the  term  chlorosis  or 
green-sickness,  ensue,  and,  without  the  strictest 
caution,  consumption  be  the  melancholy  result. 


CHAPTER  V. 

HEMOPTYSIS,    OR    PULMONARY    HEMORRHAGE. 

As  a  bleeding  from  the  lungs  is  usually  associated 
with  the  disease  under  consideration,  and  not  unfre- 
quently  exists  among  its  earliest  indications,  prior 
to  describing  the  symptoms  of  consumption,  I  will 
give  a  concise  account  of  this  species  of  hemorrhage, 
so  alarming  to  the  minds  of  most  persons. 

Predisposition.  —  In  some  constitutions  there  seems 
to  exist  a  general  predisposition  to  hemorrhage,  its 
seat  being  determined  by  age  and  the  influence  of 
what  we  denominate  occasional  causes,  as  local 
irritations,  &c.  In  some  individuals,  such  a  ten- 
dency   is   indicated   by   the   external   appearance. 


OR  PULMONARY  HEMORRHAGE.        47 

Thus  the  red  blood  appears  to  penetrate  further 
than  is  usual  into  the  fine  or  capillary  vessels  of  the 
skin;  and  so  minutely  injected  are  they  at  times, 
as'  to  give  to  the  parts  where  they  particularly 
abound,  as  the  face,  for  example,  the  semblance  of 
being  painted.  In  some  instances,  I  have  noted 
the  lips  and  cheeks  to  look  almost  as  though  smeared 
with  blood,  or  as  though  this  fluid  was  just  ready 
to  ooze  from  its  minute  vessels.  Such  a  complexion, 
however,  is  not  necessarily  associated  with  the 
tendency  to  hemorrhage;  yet,  as  stated,  will  occa- 
sionally be  witnessed. 

Again,  the  disposition  to  hemorrhage  may  exist 
only  in  the  lungs,  or  be  wholly  local. 

Symptoms.  —  The  signs  soon  preceding  the  flow 
of  blood,  vary  in  different  instances.  They  may  be 
distinct  and  strongly  marked,  or  hardly  appreciable. 
Among  the  threatening  symptoms  may  be  men- 
tioned, some  sense  of  weight,  oppression  and  anxiety 
about  the  chest,  with  more  or  less  embarrassment 
of  breathing,  especially  during  exercise,  and  a  con- 
sequent unusual  solicitude  for  fresh  air.  I  have  in 
mind  one  individual  who  remembered  no  other  sign 
premonitory  to  an  attack  of  pulmonary  hemorrhage, 
than  that  he  was  obliged,  contrary  to  his  usual 
custom,  to  sleep  with  a  window  open,  else  his 
breathing  became  distressed,  and  his  slumbers 
unquiet. 

A  sensation  of  heat  under  the  breast  bone,  lassi- 
tude, shivering,  constriction  and  paleness  of  the 
skin,    coldness    of    the    extremities,    and    perhaps 


48  HEMOPTYSIS, 

feebleness  of  tlxe  pulse,  are  sometimes  the  hasty 
Ibrerunners  of  a  discharge  of  blood  from  the  lungs. 
Or  a  feverish  state  may  precede  it,  as  increased 
heat  and  dryness  of  the  surface,  pain  in  the  back, 
loins,  &c. ;  some  degree  of  hardness  in  the  pulse, 
and,  in  short,  the  signs  of  inflammation  or  plethora 
of  the  lungs,  or  lining  membrane  of  the  air-tubes, 
the  crisis  of  which,  or  the  mode  adopted  by  nature 
for  relief,  is  a  hemorrhage. 

Occasionally,  the  bleeding  happens  without  any 
sensible  premonition ;  consequent,  perhaps,  to  some 
little  excess  of  stimulation,  undue  exposure  to  cold 
or  heat,  or  other  occasional  causes  to  be  noticed ; 
and  in  rare  instances,  without  being  referrible  to 
any  exciting  cause.  Still,  I  believe  that  careful 
observation  will  show  the  majority  of  cases  to  be 
ushered  in  by  some  febrile  excitement,  and  signs  of 
preternatural  determination  of  blood  to  the  lungs. 

Immediately  anterior  to  the  hemorrhage,  there  is 
ordinarily  experienced  a  slight  irritation  or  sense  of 
tickling  in  the  throat,  occasioning  a  hawking,  com- 
bined, perhaps,  with  a  more  or  less  distinct  cough, 
by  which,  blood,  frothy,  or  filled  with  air-bubbles, 
and  of  a  bright  arterial  or  vermilion  color,  is  ejected. 
It  is  rarely  dark  colored  or  clotted,  save  in  some 
instances  toward  the  end  of  the  attack. 

The  quantity  emitted  varies  materially  in  different 
cases,  commonly  from  several  mouthfuls  to  a  tea- 
cupful,  yet  may  occasionally  much  exceed  even  this 
latter  quantity.  Owing,  however,  to  its  bright 
color,  and  admixture  with  other  expectorated  fluids 


OR    PULMONARY    HEMORRHAGE.  49 

and  saliva,  and  the  alarm  of  the  moment,  its  amount 
is  very  apt  to  be  exaggerated. 

In  simple  bleeding  from  the  air-passages,  where 
the  lungs  are  unharmed,  and  the  system  not  reduced 
by  other  diseases,  the  discharge  is  rarely  so  abun- 
dant as  to  excite  immediate  apprehensions.  Those 
profuse  and  terrifying  discharges  which  sometimes 
occur,  are,  for  the  most  part,  associated  with  dis- 
ease of  the  lungs,  or  heart,  or  with  extreme  pros- 
tration of  the  powers  of  life  from  other  maladies. 
There  is,  also,  another  species  of  hemorrhage  from 
the  lungs,  more  deep  seated — the  blood  being  effused 
into  the  air-cells  —  more  profuse,  and  far  more  dan- 
gerous, termed  by  Laennec  and  other  modern  French 
writers,  apoplexU pulmonaire,  or  pulmonary  apoplexy, 
from  the  close  resemblance  between  the  effused 
blood  here  found  in  the  lungs,  and  that  which  is  often 
seen  in  the  brain  of  those  who  have  died  of  apoplexy. 

In  some  cases  of  hemoptysis,  pure  blood  is  not 
thrown  off  at  first,  but  the  common  mucus  of  the 
air-passages,  more  or  less  tinged  with  it.  This 
bloody  mucus  may  be  expectorated  for  a  longer  or 
shorter  period,  and  then  cease,  or  be  followed  by  a 
considerable  gush  of  pure  blood. 

Sometimes  the  hemorrhage  will  continue  in  a 
slight  degree  for  several  days ;  again,  it  immediately 
relieves  the  loaded  vessels,  and  ceases.  It  may 
continue  to  recur  at  more  or  less  distant  intervals, 
or  no  return  of  it  be  ever  again  experienced. 

The  effect  on  the  system  is  sometimes  quite 
trilling,  the  individual  being  almost  at  once  able  to 
7 


50 


MEMOrTV.SIS, 


attend  to  his  ordinary  avocations.  At  otheis,  faint- 
ing ensues,  and  a  general  prostration  of  the  bodily 
powers,  quite  disproportioned  to  the  amount  of* 
blood  lost. 

Hemoptysis  will  often  afford  sudden  relief  to 
embarrassments  in  the  lungs,  as  a  bleeding  from 
the  nose  frequently  cures  headach  and  oppression 
of  the  brain. 

Causes. — Most  of  the  causes  of  pulmonary  he- 
morrhage are  of  a  similar  nature  to  those  which 
tend  to  originate  consumption,  and  which  are 
hereafter  to  be  described.  Among  them  may  be 
enumerated  cold  and  variable  conditions  of  the 
atmosphere,  as  during  our  winters  and  the  early 
part  of  spring.  Exposure  to  cold  and  dry  winds. 
Diminution  of  atmospheric  pressure,  as  on  the  ascent 
of  very  lofty  mountains.  Extraordinary  exertions 
of  the  fimction  of  respiration,  as  in  playing  on  wind 
instruments,  and  in  long  continued  and  loud  speak- 
ing. Moliere,  we  are  told,  died  of  pulmonary 
hemorrhage  immediately  after  the  fourth  perform- 
ance of  his  Malade  Imaginaire.  Irritating  substances 
inhaled  into  the  lungs.  Intemperance  in  the  use  of 
vinous  or  spirituous  liquors,  or  whatever  occasions 
a  plethoric  state  of  the  system.  Undue  physical 
exertions ;  thus  I  have  known  it  come  on  immedi- 
ately after  long  and  very  rapid  walking.  Sudden 
suppression  of  habitual  discharges,  or  cutaneous 
eruptions.  Strong  moral  affections.  Broussais  re- 
lates an  instance  where  a  lady  sitting  on  the  grass, 
felt  a  living  frog  fall  into  her  bosom  fi'om  the  claws 


OR    PUL:\rOXARY    HEMORRHAGE.  51 

of  a  bird  of  prey,  and  was  instantly  seized  with  so 
copious  an  hemoptysis  that  she  survived  but  a  few 
minutes.  It  is  a  familiar  fact  that  in  some  consti- 
tutions bleeding  from  the  nose  is  liable  to  ensue 
under  the  sudden  influence  of  violent  passions. 

Relative  prevalence  in  the  tivo  sexes.  —  The  obser- 
vations of  the  French  writers  go  to  prove  that  this 
affection  is  more  common  among  females  than  males. 
Louis  tells  us  in  the  proportion  of  three  to  two. 
Hemorrhage  from  the  stomach,  or  vomiting  of  blood, 
has  appeared  to  me  to  be  more  frequent  in  women 
than  in  men ;  but  I  much  question  whether  the 
observations  of  our  medical  men  in  relation  to 
bleeding  from  the  lungs  would  lead  to  like  results 
w^ith  those  of  the  French  physicians. 

Ages  in  which  it  most  commonly  occurs.  —  Hemop- 
tysis is  not  usual  before  puberty.  In  New  England 
I  think  the  greater  number  of  instances  of  it  will  be 
found  to  occur  between  the  ages  of  eighteen  and 
thirty-five  or  forty.  Still  it  may  happen  even  in 
old  age.  The  limited  number  of  cases  observed  by 
Louis  in  reference  to  this  question,  go  to  show  that 
as  many  males  are  affected  with  it  above,  as  under 
forty  years  of  age. 

Pathology,  or  nature  of  the  disease.  —  The  commonly 
received  opinion  is,  that  hemorrhage  from  the  lungs 
is  owing  to  the  rupture  of  a  blood-vessel,  and  which 
is  supposed  to  heal  with  very  great  difficulty.  Such 
may  sometimes  be  the  case,  as  in  the  last  stages  of 
consumption,  where  there  is  great  destruction  of 
the  organization  of  the  lungs;, yet  in  ordinary  in- 


52  llI'MOl'TVSTS, 

stances,  tlio  l)loocl  is  effused  from  the  pores  of  the 
mucous  or  linin<^  membrane  of  the  air-passages, 
independent  of  any  rupture,  in  the  same  manner  as 
it  sometimes  oozes  from  the  gums,  eyes,  skin,  and 
other  parts,  in  scurvy,  the  last  stages  of  low  fevers, 
&:c.  The  vessels  which  in  their  natural  state  admit 
the  passage  only  of  colorless  fluids,  as  the  watery 
exhalation  from  the  lungs,  and  the  transpiration  by 
the  skin,  having  their  healthy  functions  altered,  or 
greatly  depressed,  allow  the  red  blood  to  pass  them. 
The  popular  apprehension,  therefore,  from  a  broken 
blood-vessel,  is,  for  the  most  part,  unfounded. 

Danger  of  the  disease.  —  The  affection  I  am  con- 
sidering is  in  a  special  manner  alarming,  from  its 
frequent  and  intimate  connexion  with  consumption, 
and  hence  should  ever  awaken  the  most  anxious 
solicitude  when  occurring  in  a  system  predisposed 
to  this  disease. 

Hemoptysis,  though  often,  still  is  not  necessarily 
associated  with  a  consumptive  habit,  but  may  happen 
in  persons  of  well  formed  chests,  whose  lungs  are 
in  other  respects  sound,  and  in  whom  there  exists 
no  reason  for  suspecting  any  tuberculous  tendency. 
Some  persons  are  liable  to  occasional  spittings  of 
blood,  and  without  any  material  effect  on  their 
health,  during  a  long  life.  Dr  Heberden  saw  a 
woman  at  seventy,  in  good  condition,  who  for  fifty 
years  had  never  been  free  from  spitting  of  blood 
a'bove  tw^o  years  together. 

Treatment.  —  It  comes  within  my  plan  to  say  but 
little  on  this  subject,  as  the  various  active  remedies 


OR    PULMOXARY    nE:\rORIlHAGE.  53 

sometimes  demanded,  as  bleeding,  blisters,  powerful 
astringents,  &:c.,  should  only  be  employed  under 
the  immediate  direction  of  a  physician. 

During  the  attack,  and  commonly  for  some  days 
succeeding  it,  perfect  rest  and  absolute  silence  are 
to  be  observed.  The  apartment  of  the  individual 
ought  to  be  large  and  cool,  and  fresh  air  freely 
admitted.  A  vegetable  diet  of  a  simple  and  digest- 
ible character,  should  be  strictly  adhered  to,  and 
the  drinks  taken  cool,  and  acidulated  with  some  of 
the  vegetable  or  mineral  acids,  as  the  lemon  or 
elixir  vitriol.  Every  stimulant,  in  short,  both  of  a 
moral  and  physical  nature,  should  be  scrupulously 
avoided. 

With  a  view  to  check  the  bleeding,  Dr  Rush 
advised  the  use  of  common  salt,  which  has  now^ 
become  quite  a  popular  remedy.  It  may  be  taken 
in  the  dose  of  a  teaspoonful  every  half  hour  till  the 
hemorrhage  abates. 

Alum,  also,  may  be  safely  resorted  to  where  the 
bleeding  is  profuse  and  the  system  prostrated,  in 
the  dose  of  eight  or  ten  grains  or  more,  dissolved 
in  about  a  gill  of  soft  water.  Or  if  time  is  allowed, 
alum  whey  may  be  employed,  prepared  thus :  Two 
drachms  of  alum  added  to  a  pint  of  milk,  and  this 
boiled  and  stirred  till  all  the  whey  is  separated, 
then  strained,  and  one  or  two  tablespoonfuls  taken 
every  quarter  or  half  hour.  Iced  water  and  the 
common  elixir  vitriol  may  also  be  employed  to  check 
the  hemorrhao:e. 

After  the  bleeding  has  ceased,  and  especially  if 


54  SYMPTOMS 

any  predisposition  to  tubercles  is  suspected,  the 
various  means  preventive  of  consumption,  hereafter 
to  be  enumerated,  should  be  assiduously  prosecuted. 
Journeying,  sea  voyages,  and  mild  climates  are  in  a 
particular  manner  beneficial  to  the  subjects  of  he- 
moptysis. 


CHAPTER  VI. 

HISTORY    OF    THE    SYMPTOMS    OF    CONSUMPTION. 

I  PURPOSE  in  the  two  ensuing  chapters  to  give  a 
general  account  of  the  phenomena  witnessed  during 
the  ordinary  course  of  well  marked  cases  of  tuber- 
culous phthisis. 

There  exist  in  consumption,  as  well  as  in  many 
other  affections  of  the  chest,  an  important  and 
interesting  class  of  symptoms,  called  physical ;  but 
as  they  can  only  be  appreciated  by  the  scientific 
and  experienced  physician,  they  will  of  course  be 
omitted  in  the  present  work.  They  are  derived 
especially  from  auscultation  and  percussion.  The 
former,  means  a  hearkening  to  the  modifications  of 
sound  produced  in  the  chest  by  disease,  during 
respiration,  coughing  and  speaking,  either  by  the 
ear  applied  directly  to  it,  or  through  the  medium  of 
an  instrument  denominated  the  stethoscope.  The 
latter,  or  percussion^  consists  in  eliciting  sounds  by 
suddenly  striking  some  part  of  the  chest  with  the 


OF    CONSUMPTION.  55 

hand,  or  tip  of  the  fingers,  and  instituting  a  com- 
parison between  those  so  produced  in  healthy  and 
morbid  states  of  the  organs  within  the  thorax. 

Premonitory  and  early  symptoms.  —  The  mode  of 
attack  and  progress  of  consumption  vary  in  different 
cases.  In  some  instances,  an  irritating  cough  will 
come  on,  after  a  time  subsiding,  then  recurring,  till 
finally  the  characters  of  the  disease  become  too 
plain  to  be  mistaken.  Again,  the  cough,  with 
occasional  and  slight  remissions,  may  last  for  months, 
and  in  rare  cases  even  for  years,  before  the  true 
nature  of  the  disease  is  fully  made  known.  Here 
the  protracted  cough  is  probably  owing  to  the  irri- 
tation of  crude  tubercles  in  the  lungs.  It  may  be 
dry,  or  accompanied  with  a  more  or  less  free 
expectoration  of  the  common  mucus  of  the  air- 
passages,  and  often  closely  resembles  that  resulting 
from  an  ordinary  cold,  to  which  cause  it  is  usually 
attributed. 

Sometimes  the  earliest  symptoms  of  the  disease 
are  those  of  an  acute  pulmonary  catarrh,  or  cold  on 
the  lungs;  or  an  hemoptysis  may  awaken  our  first 
suspicions.  Occasionally  it  is  ushered  in  by  symp- 
toms of  lung  fever,  or  acute  pulmonary  inilammation, 
as  severe  pain  in  the  side,  great  embarrassment  of 
respiration,  heat  and  dryness  of  the  skin,  fiushing 
of  the  face,  rapid  and  hard  pulse.  Under  right 
management,  these  phenomena  may  quickly  subside, 
or  at  any  rate  abate  in  their  severity,  but  con- 
sumption is  unexpectedly  declared.  Under  such 
circumstances,  there  is  probably  an  attack  of  acute 


5()  SVMPTUJMS 

inflammation  in  the  vicinity  of  crude  tubercles 
already  in  existence,  excited,  perhaps,  by  their 
irritation,  which  reacting  on  these  morbid  bodies 
hastens  on  their  suppurating  or  softening  process. 
Such  cases  not  unliequently  run  their  course  with 
great  celerity,  and  constitute  instances  of  acute 
phthisis  to  which  I  am  presently  to  allude. 

I  will  now  describe  the  more  usual  and  regular 
course  of  consumption.  —  At  first  there  will  proba- 
bly be  experienced  some  slight  irritation  in  the 
larynx  or  top  of  the  windpipe,  more  strikingly  re- 
marked in  the  morning  on  first  rising  from  bed. 
Various  circumstances  will  be  observed  to  aggra- 
vate or  excite  it,  as  going  up  stairs,  ascending  any 
steep  elevation,  or  quick  exercise  of  any  descrip- 
tion ;  exposure  to  cold  air,  loud  or  long  speaking, 
a  deep  inspiration,  &c.  This  irritation  occasions  a 
hawking,  or  a  slight  cough,  by  which  a  little  frothy 
fluid  like  the  saliva,  blended  perhaps  with  the  com- 
mon mucus  of  the  air  passages,  is  discharged. 
These  symptoms  excite  but  trifling  regard,  and  are 
commonly  attributed  to  transient  and  accidental 
causes. 

In  union  with  the  above,  careful  observation  will 
almost  always  detect  other  suspicious  signs.  Though 
in  some  instances,  there  may  exist  an  unusual  and 
more  or  less  constant  mental  excitement,  yet  more 
ordinarily  there  is  manifested  an  unaccountable 
sense  of  languor,  attended  with  a  diminution  both  of 
the  intellectual  and  physical  capabilities,  and  a  con- 
sequent disinclination  to  the  accustomed  occupations 


OF    CONSL.MrTlON,  57 

ofliie.  The  breathing  too,  especially  in  a  conhned 
room,  or  a  crowd,  is  less  free  and  tranquil  than  nat- 
ural, on  which  account  there  is  an  unwonted  anxiety 
for  fresh  air.  The  respiration,  moreover,  becomes 
especially  disturbed  on  ascending  quickly  an  eleva- 
tion, or  from  any  active  physical  exertion,  or  sudden 
moral  emotion. 

Pains  in  the  chest  and  other  parts,  as  the  shoul- 
ders and  extremities,  fixed  or  wandering,  and  more 
or  less  distinct  and  constant,  are  occasionally  noticed 
among  the  earliest  symptoms  of  consumption.  In 
some  instances  pain  may  not  be  experienced  at  all, 
or  only  at  the  end  of  a  deep  inspiration.  I  am 
inclined  to  think  that  a  sense  of  uneasiness,  or  op- 
pression about  the  chest,  is  more  frequent  in  the 
early  stage  and  regular  forms  of  the  disease,  than 
acute  pain. 

Indigestion  or  dyspepsia  may  exist  among  the 
earliest  signs  of  consumption,  and  by  particularly 
engrossing  attention,  too  often  diverts  it  from  the 
primary  and  momentous  disease.  But  though  symp- 
toms of  indigestion  usually  mark  the  commencement 
of  phthisis,  yet,  when  the  disease  has  fully  established 
itself  in  the  system,  the  digestive  organs  not  unfre- 
fluently  experience  very  obvious  relief 

Cases  happen,  however,  where  from  the  very 
first,  the  digestive  function  appears  to  maintain  its 
integrity,  and  remains  comparatively  unharmed  amid 
the  progressive  ravages  of  this  wasting  malady.  I 
have  not  a  few  times  remarked  this  in  subjects  dis- 
playing a  deep  tuberculous  taint,  and  in  whom  the 
8 


58  svi\ipi"o:\is 

disease  never  deviated  in  its  onward  course ;  the 
lungs,  if  I  may  so  say,  seeming  by  a  sort  of  revul- 
sion, to  engross  and  concentrate  within  themselves, 
all  morbid  action.  In  such  cases  we  feel  more 
assured  of  the  fatal  termination,  inasmuch  as  no 
hope  can  be  indulged  that  the  symptoms  are  the 
secondary  result  of  digestive  derangement. 

Extreme  irritability  of  temper — more  especially 
when  dyspepsia  is  present,  —  not  unusually  attends 
the  early  period  of  consumption,  manifested  by 
frequent  and  unreasonable  bursts  of  passion,  and 
a  striking  perversion  of  moral  feeling.  I  have  in 
general,  however,  remarked  the  temper  to  be  more 
uniformly  calm,  placid  and  resigned,  in  those  sub- 
jects described  as  possessing  a  fair  complexion,  with 
a  general  softness  and  delicacy  of  structure,  than  in 
such  as  display  the  opposite  temperament. 

The  voice  often  undergoes  an  alteration,  more  or 
less  remarkable  in  different  cases.  It  may  be 
hoarser  and  deeper  toned,  or  smaller  and  more  feeble 
than  natural,  and  talking  is  apt  to  weary  and  excite 
the  cough.  In  some  instances  it  becomes  unusually 
shrill,  harsh,  and  unpleasant  to  the  ear. 

There  are  some  extremely  severe  cases  of  con- 
sumption, in  which  the  larynx,  or  organ  particularly 
concerned  in  the  formation  of  the  voice,  participates 
very  early  in  the  disease ;  hence  speaking  becomes 
difficult,  painful,  and  occasions  an  irritating  cough, 
and  ultimately  can  only  be  conducted  in  a  whisper. 

The  victims  of  consumption,  in  its  early  stage  cer- 
tainly, and  many  times,  almost  to  its  close,  appear 


OF    CONSUINIPTIOX.  59 

quite  unsuspecting  of  danger,  and  even  seem  loath 
that  such  suspicion  should  rest  in  the  minds  of  oth- 
ers. Hence  they  incline  to  speak  lightly  of  their 
complaint,  particularly  to  their  medical  adviser, 
often  keeping  back  some  symptoms,  and  giving  too 
favorable  a  representation  of  others,  so  that,  unless 
wary,  he  may  be  led  into  error. 

The  condition  of  the  mind,  as  already  asserted, 
varies  in  different  cases  and  at  different  times,  in  this 
early  stage.  Sometimes  the  thoughts  are  clear  and 
even  brilliant,  and  the  individual  has  turns  of  being 
particularly  cheerful  and  disposed  to  conversation. 

Burnings  of  the  feet  and  hands  are  now  often  ex- 
perienced, alternating,  perhaps,  with  coldness.  In 
truth,  tuberculous  subjects  often  suffer  much  from 
coldness  of  the  extremities,  particularly  of  the  feet. 
Flushing  of  the  face  is,  likewise,  readily  brought  on 
by  indigestion,  or  any  physical  or  moral  excitement. 

The  eyes  often  vary  from  their  natural  expression. 
In  some  instances  being  morbidly  bright,  in  others 
dull  and  vacant.  The  nights  are  apt  to  be  restless, 
and  the  slumbers  disturbed  by  unpleasant  dreams. 

Such  threatening  signs  should  ever  awaken  the 
most  lively  apprehensions,  and,  in  a  special  manner, 
if  there  exist  indications  of  a  consumptive  predispo- 
sition. They  may  occasionally  last  for  a  consid- 
erable period  without  manifesting  any  remarkable 
change  or  aggravation,  or  may  even  undergo  an 
evident  abatement.  It  is  these  delusive  pauses,  so 
common  in  consumption,  which  serve  to  cherish 
hopes  that  flatter  but  to  deceive. 


60 


.SNMP'ro.MS 


Tlie  disease,  however,  wlien  once  begun,  for  the 
most  part,  goes  on  advancing  —  though  with  more 
or  less  uniformity  and  rapidity  in  different  instances, 
—  till  every  doubt  of  its  melancholy  nature  is  ban- 
ished from  (he  minds  of  all,  save,  perhaps  of  him 
who  is  its  unhappy  subject. 

Symptoms  of  the.  disease  ivhen  fully  declared. — The 
flesh  now  w^astes  very  rapidly,  and  even  in  cases 
where  the  appetite  and  digestive  powers  appear  but 
little  impaired.  The  pulse  are  constantly  accele- 
rated, and  become  extremely  rapid  under  any  ex- 
citement, whether  of  a  moral  or  physical  character. 

The  countenance  exhibits  a  surprising  change. 
It  is  shrunken,  contracted,  its  features  sharpened, 
and  a  deathlike  paleness  is  often  seen  alternating 
with  a  glowing  hectic  Hush.*  The  eye  frequently 
appears  enlarged,  owing  to  the  dilatation  of  its  pupil, 
and  its  expression  unnatural  and  painfully  glaring. 

Vicarious  pains  are  ofttimes  experienced  in  differ- 
ent parts  of  the  body,  though  by  no  means  constant 
or  essential  to  the  disease.  They  exist  in  different 
degrees,  and  are  very  apt  to  be  regarded  as  rheu- 
matic affections. 

Pains  in  the  chest  afflict  most  subjects  at  some 
periods  of  the  disease,  but  are  not  essential  to  it, 
being  absent  in  some  cases.  Sometimes  they  are 
trifling  and  occasion  but  little  suffering,  at  others 

"  In  occasional  instances  there  may  exist  some  bloating  of  the  face,  even 
when  the  disease  is  fully  manifested  ;  and  some  individuals  from  its  nat- 
ural shape  and  abundance  of  cellular  substance,  show  emaciation  of  the 
face  much  less  readi'v  than  others. 


OF    CONSUMPTION.  61 

they  are  acute  and  distressing.     They  are  particu- 
larly experienced  during  inspiration. 

The  observations  of  the  best  modern  pathologists 
render  it  highly  probably  that  —  certainly  in  the 
majority  of  cases,  —  the  acute  pains  suffered  in  the 
chest  are  not  owing  to  the  tubercles  existing  there, 
but  to  common  inflammation  in  portions  of  the  lungs 
or  pleura  in  their  vicinity,  and  excited  by  their  irri- 
tation. Louis  attributes  them  to  partial  chronic 
pleurisies,  causing  those  adhesions  between  the 
external  surface  of  the  lungs  and  inner  walls  of  the 
chest,  so  commonly  found  after  death  in  the  neigh- 
borhood of  tubercles  or  tuberculous  excavations. 
The  most  weighty  reasons  for  this  belief  are,  that 
tubercles  in  other  situations  are  not  apt  to  cause 
pain;  and  furthermore,  that  pain  in  the  chest  may 
not  exist  at  all,  or  be  only  occasional  and  transient, 
while  the  tuberculous  disease  is  constantly  pro- 
gressing. 

Oppression  and  embarrassment  of  the  respiration 
will  of  course  be  experienced,  though  often  in  a  less 
degree  than  we  should  anticipate,  having  in  mind 
the  great  destruction  that  is  going  on  in  the  lungs. 
Instances  even  happen  where  the  breathing  is  but 
little  disturbed,  save  under  the  influence  of  causes 
not  connected  with  the  malady  ;  as  undue  exertions, 
moral  emotions,  indigestion,  the  injudicious  use  of 
tonics  and  stimulants,  a  too  nutritious  diet,  or  the 
supervention  of  common  inflammation.  Sometimes, 
distressing  palpitations  of  the  heart  are  added  to 
the  other  embarrassments  experienced  in  the  chest. 


Irregular  and  transient  feverish  symptoms  often 
occm*  in  the  early  stage  of  consumption,  but  as  it 
progresses,  distinct  paroxysms  of  hectic  fever  take 
place.  In  some,  they  occur  early ;  in  others,  not 
till  near  the  close  of  the  disease ;  the  disposition  to 
hectic  seeming  to  be  more  or  less  strong  in  different 
constitutions. 

The  phenomena  of  hectic  fever  vary  somewhat, 
though  not  essentially,  in  different  subjects.  At 
first,  there  may  be  but  one  paroxysm  in  the  twenty- 
four  hours,  commencing  in  the  latter  part  of  the 
day  or  evening ;  but,  for  the  most  part,  in  the 
advance  of  the  disease,  two  fits  occur ;  one  happen- 
ing near  noon,  and  lasting,  perhaps,  till  the  latter 
end  of  the  afternoon,  when  the  symptoms  abate,  or 
remit  for  a  short  period  —  differing  somewhat  in  its 
duration,  —  a  new  access  occurring  some  time  in  the 
night,  may  be  not  till  midnight.  The  second  fit  is 
commonly  the  more  severe  and  perfect.  The  new 
paroxysms  are  ofttimes  ushered  in  by  chills,  or  at 
least  an  increased  sensibility  to  cold ;  and  occa- 
sionally marked  rigors  have  returned  at  regular 
periods,  imitating  some  forms  of  our  agues.  As 
the  disease  draws  towards  its  termination,  the 
remissions  become  less  and  less  distinct,  till  at 
length  the  sufferer  appears  almost  constantly  to  be 
laboring  under  a  hectic  paroxysm. 

There  are  peculiarities  about  this  fever  which 
cannot  fail  to  strike  even  the  most  ordinary  observer. 
A  bright,  and  often  distinctly  circumscribed  flush 
paints  the  cheeks,  heightened  by  contrast  wnth  the 


OF    COXSUMPTION,  63 

paleness  in  its  vicinity.  In  union  with  this  hectic 
glow,  the  morbid  brightness  of  the  eyes,  the  con- 
traction of  the  brows,  and  sharpened  features,  give 
to  the  whole  countenance  an  expression  of  the  most 
unnatural  and  painful  character. 

Sometimes  one  cheek  displays  a  much  brighter 
color  than  the  other,  or  the  flush  may  even  be 
limited  for  a  period  to  one  side  of  the  face. 

During  the  hectic  fit,  the  cough  becomes  aggra- 
vated, and  the  expectoration  less  free.  There  is 
an  uncomfortable  burning  of  the  extremities,  and  a 
distressful  restlessness.  The  pulse  are  greatly 
accelerated — sometimes  exceeding  a  hundred  and 
twenty  beats  in  a  minute,  —  are  often  very  small, 
and  occasionally  slightly  hard.  The  state  of  the 
respiration  varies,  becoming  somewhat  more  rapid, 
yet  it  is  often  less  disturbed  than  might  be  anticipated 
from  the  aggravation  of  the  other  symptoms.  The 
head  is  often  quite  free  from  pain  or  uneasiness,  and 
though  the  mind  may  be  occasionally  somewhat 
confused,  yet  it  is  more  frequently  clear,  and  a  little 
excited. 

The  digestive  powers  do  not  appear  to  suffer 
materially.  The  tongue  is  often  moist  and  clean, 
though  a  little  redder  than  natural,  and  the  thirst 
not  necessarily  great.  Toward  morning,  a  sweat 
breaks  out,  at  times  extremely  profuse,  soaking 
almost  through  the  bed,  and  greatly  exhausting  the 
bodily  energies.  It  is  particularly  abundant  when 
the  disease  is  far  advanced,  the  body  seeming  almost 
as  though  it  was  di'^sohing  into  a  fluid,  hence  the 


64  yV.MPTOMS 

term  coiliqualive  is  applied  to  such  sweats.  The 
sufferer  now  becomes  a  little  more  tranquil,  perhaps 
falls  into  a  sleep,  and  unless  the  sweating  continues 
profuse,  awakes  somewhat  refreshed.  As  in  our 
common  agues,  this  sweating  constitutes  the  crisis  or 
termination  of  the  paroxysms  when  regular,  and,  as 
in  them,  is  frequently  attended  with  much  distress, 
as  well  as  exhaustion. 

In  some  cases  of  consumption,  debilitating  sweats 
are  sure  to  ensue  whenever  the  individual  falls 
asleep.  Many  times  they  attend  even  the  early 
stage,  being  general,  or  partial  and  transient. 
There  are  instances,  too,  in  which  the  sweats  either 
do  not  occur  at  all,  or  not  till  toward  the  very  close 
of  the  malady ;  and  also  where  they  have  come  on, 
and  then  intermitted,  not  recurring  till  shortly 
before  death. 

When  the  hectic  fever  has  become  manifest  in 
females,  the  menstrual  discharge,  if  not  already 
suppressed,  commonly  stops.  Perhaps  becommg 
irregular  for  a  longer  or  shorter  period  anterior  to 
its  cessation.  Sometimes  a  suppression  of  this 
function  is  among  the  earliest  manifestations  of 
phthisis,  when  heating  and  stimulating  remedies, 
highly  aggravating  to  the  disease  in  the  lungs,  are 
too  often  resorted  to,  with  a  view  to  restore  the 
discharge,  under  the  false  idea  that  its  interruption 
is  the  occasion  of  all  the  other  difficulties.  Here, 
as  too  often  happens  in  medicine,  an  effect  is  mis- 
taken for  a  cause.  Whenever  signs  of  consumption 
begin  to  display  themselves,  all  remedies  should  be 


OF  coxsu:\iPTiox.  65 

administered  with  special  reference  to  the  state  of 
the  lungs,  and  if  we  can  relieve  their  morbid  con- 
dition, all  the  other  symptoms  growing  out  of  it 
will,  as  a  necessary  consequence,  subside. 

The  cough,  at  the  period  of  the  disease  I  am 
describing,  generally  assumes  a  more  decided  char- 
acter, and  is  readily  brought  on  by  slight  exertion, 
or  excitement  of  any  description.  In  many  instances 
it  is  extremely  severe,  frequent  and  harassing, 
accompanied  with  difficulty  of  expectoration,  and 
allowing  but  short  and  uncertain  intervals  of  rest 
to  the  unhappy  sufferer.  It  is  more  especially  apt 
to  occur,  and  in  an  aggravated  degree,  on  first 
awaking  in  the  morning,  and  in  a  particular  manner 
on  rising  from  the  horizontal  posture.  At  this  time, 
it  is  not  unusually  attended  by  some  vomiting. 
Though  in  some  cases,  sickness  and  vomiting  arise 
from  other  causes,  and  are  very  frequent  and  dis- 
tressing, yet  they  are  for  the  most  part  excited  by 
the  cough. 

The  quantity  of  matter  expectorated  is  by  no 
means  a  sure  indication  of  the  degree  of  pulmonary 
disease.  It  may  be  large  when  the  affection  is 
neither  extensive  nor  advanced  in  its  progress,  and 
quite  small,  though  the  lungs  are  crowded  with 
tubercles,  and  many  in  their  stage  of  suppuration. 

The  sensible  qualities  of  the  expectoration  have 
been  a  good  deal  studied  as  indications  of  the  exist- 
ence of  phthisis.  It  was  once  imagined  that  a 
discharge  of  pus  from  the  lungs  was  sufficient 
evidence  of  ulceration  in  these  organs,  and  hence  a 
9 


66  SYMPTOI\IS 

variety  of  chemical  tests  were  employed  to  distin- 
guish it  from  the  common  mucous  secretions.  Pure 
pus  is  more  opaque,  and  ordinarily  heavier  than 
mucus,  sinkins;  in  water,  and  has  also  a  sweetish 
taste.  But  its  presence  in  the  expectoration  is  far 
from  proving  the  existence  of  consumption,  since  it 
is  often  secreted  by  the  lining  membrane  of  the  air 
passages  in  common  pulmonary  catarrh. 

The  matter  expectorated  in  consumption  is  not 
derived  solely  from  the  ulceration  which  is  going  on 
in  the  lungs.  In  the  early  period  of  the  disease, 
anterior  to  the  maturation  or  softening  of  the  tuber- 
cles, it  must  be  supplied  altogether  from  the  mucous 
membrane  of  the  air  tubes,  as  in  a  common  cold. 
Later,  the  softened  tuberculous  matter  is  added; 
and  Laennec  supposes  that  the  internal  surfaces  of 
tuberculous  excavations  are  capable,  in  some  in- 
stances, of  secreting  pus.  The  tubercles,  more 
particularly  when  maturated,  become  a  source  of 
unnatural  irritation  to  the  lining  membrane  of  the 
air-passages  in  their  vicinity,  greatly  augmenting  as 
well  as  depraving  its  secretions.  These  different 
substances  are,  for  the  most  part,  so  intimately 
blended  with  each  other,  that  their  individual 
characters  are  not  easily  discriminated. 

The  relative  proportion  of  the  tuberculous,  com- 
pared with  the  other  constituent  matters,  though 
varying  in  different  instances,  still  is  apt  to  be 
much  smaller  than  is  generally  believed.  Laennec 
—  supposing  the  daily  discharge  to  exceed  a  pound, 
and  taking  into  view  how  slowly  excavations  empty 


OF    CONSUMPTION.  67 

themselves,  —  thinks  it  probable  that  the  matter 
from  the  tubercles  cannot  amount  to  more  than 
twelve  grains;  that  is,  a  thousandth  part  of  the 
whole.  The  relative  amount  must  of  course  vary 
greatly,  and  cannot  be  accurately  computed ;  yet  I 
conceive  that  Laennec  has  placed  his  estimate  too 
low.  Consumption,  then,  commonly  excites  a  pul- 
monary catarrh,  to  which  is  referrible  the  larger 
proportion  of  the  expectoration. 

In  some  individuals  there  is  secreted  by  the 
tonsils,  a  concrete,  cheesy  substance,  of  a  dirty, 
yellowish  white  color,  and  much  resembling  the 
matter  of  crude  tubercles.  I  have  known  it  formed 
quite  largely,  even  in  health ;  and  under  the  sup- 
position that  it  came  from  the  lungs,  to  be  the 
occasion  of  much  alarm.  But  it  is  very  rare  during 
any  stage  of  consumption,  that  tuberculous  matter 
of  this  consistence  is  expectorated.  If  rubbed  be- 
tween the  fingers,  it  emits  an  extremely  disagreeable 
fetor,  which  is  not  the  case  with  crude  tubercle. 

As  yet,  we  are  acquainted  with  no  one  sensible 
property  of  the  expectoration  which  invariably  in- 
dicates to  us  the  presence  of  tubercles  in  the  lungs. 
Still,  a  careful  observation  of  its  different  modifica- 
tions and  progressive  changes  will,  in  union  with 
other  symptoms,  aiford  important  aid  in  detecting 
their  existence.  I  will,  therefore,  briefly  notice 
some  of  the  appearances  of  the  expectorated  matter, 
which  are  generally,  though  not  uniformly  witnessed 
in  the  disease  under  consideration. 

At  first  the  cough  may  be  dry,  or  attended  by  the 


68  SYMPTOMS 

discharge  of  a  watery  or  slightly  viscid,  colorless, 
frothy  iluid.  As  the  disease  advances,  the  expec- 
toration becomes  thicker,  more  opaque,  greenish, 
and  has  frequently  intermixed  with  it,  small  lines  or 
fine  streaks  of  a  yellow  color.  Little  yellowish  or 
dull  white  specks  are  also  often  observed  in  it, 
varying  in  size  from  that  of  the  head  of  a  pin  to  a 
grain  of  rice ;  and  Bayle  has  compared  them  to  this 
grain  when  boiled.  Sometimes  the  expectoration 
assumes  the  form  of  roundish  masses,  displaying  a 
yellowish  white  or  ash  color,  and  shaggy  surface. 
Dr  Forbes  has  described  this  peculiarity  as  consist- 
ing of  a  series  of  globular  masses  of  a  whitish  yellow, 
rugged,  woolly  surface,  resembling  somewhat  little 
rolled  balls  of  cotton  or  wool,  and  which  usually,  but 
not  always,  sink  in  water.  He  has  noticed  it  most 
frequently  in  young  subjects  of  a  strongly  marked 
scrofulous  habit,  and  in  whom  consumption  was 
hereditary.  He  states,  too,  that  this  character  of 
the  expectoration  has  always  seemed  to  him  as 
surely  marking  the  existence  of  phthisis.  Still,  in 
some  rare  instances,  it  has  been  seen  to  exist  in 
simple  catarrh. 

Numerous  other  modifications  of  the  discharge 
are  also  witnessed.  It  is  ofttimes  extremely  adhe- 
sive, being  detached  from  the  fauces  with  much 
difficulty.  At  times  it  closely  resembles  pus  from 
a  common  abscess,  and  may  exhibit  a  yellowish, 
greenish,  or  grayish  color.  In  some  instances,  a 
little  blood  will  be  intimately  blended  with  the  mat- 
ter, assimilating  it  in  its  hue  to  brickdust.     Or  there 


OF    CONSUMPTION.  69 

may  be  a  slight  hemorrhage  imparting  to  it  a  bright 
red  color.  It  will  occasionally,  also,  nearly  resem- 
ble unstrained  whey.  It  may  be  very  fetid,  slightly 
so,  or  what  is  more  common,  without  any  remark- 
able unpleasant  odor.  Sometimes  there  will  take 
place  a  sudden  and  copious  discharge  of  purulent 
matter,  perhaps  quite  offensive  to  the  smell,  and, 
being  usually  attributed  to  the  breaking  of  an  ab- 
scess, is  the  occasion  of  no  small  alarm  both  in  the 
minds  of  the  subject  and  his  friends. 

Instances  occur,  where  the  cough  is  but  trifling 
through  the  whole  disease ;  and  also  where  it  does 
not  come  on  till  its  latter  stage.  Cases  have  even 
happened,  where  there  has  been  either  no  cough  at 
all,  or  not  till  a  few  days  prior  to  dissolution.  Such, 
to  be  sure,  are  exceptions  to  the  ordinary  course  of 
consumption,  yet  important  to  be  noticed,  since  a 
cough  is  so  generally  regarded  as  essential  to  its 
existence.  How  often  the  expression  is  heard  from 
the  lips  of  those  w'asting  under  this  disease  —  "  Why, 
I  am  sure  I  cannot  be  in  a  consumption,  for  I  have 
no  cough!"  The  malady  is  not  to  be  known  by 
the  cough,  merely,  but  by  the  careful  observation 
of  all  its  various  symptoms,  and  in  their  relation 
with  each  other. 

There  are  nervous  coughs,  gastric  coughs,  &c., 
which,  without  careful  examination,  may  sometimes 
excite  the  suspicion  of  consumption.  The  veteran 
spirit-drinker  is  liable  to  a  morning  cough,  not  un- 
frequently  leading  his  friends  into  the  erroneous 
opinion  that  he  is  laboring  under  this  fatal  malady ; 


70  SYMPTOMS 

and  he  himself  is  very  willing  that  it  should  be  re- 
ferred to  any  cause  rather  than  the  true  one.  It  is 
very  harassing  on  first  rising  in  the  morning,  for  it 
is  at  this  period  especially  that  the  intemperate 
man  must  taste  the  bitter  dregs  of  his  yesterday's 
delicious  cup.  This  cough  is  commonly  terminated 
by  the  expectoration  of  a  tough  glairy  mucus,  and 
often  by  a  vomiting  of  a  greenish  bitter  fluid,  more 
or  less  blended  with  tenacious  mucus.  It  is,  for  the 
most  part,  the  consequence  of  a  deranged  state  of 
the  digestive  organs,  yet  if  there  is  any  predisposi- 
tion to  tubercles  in  the  lungs,  it  will,  probably, 
sooner  or  later  call  them  into  existence. 

As  the  disease  progresses,  more  or  less  rattling  is 
heard  in  the  air  passages,  caused  by  the  air  passing 
through  fluids  there  accumulated.  It  has  with  truth 
been  remarked  by  Laennec,  that  in  some  cases  the 
subjects  are  sensible  of  the  gurgling  of  tuberculous 
matter,  and  can  even  point  out  the  spot  from  whence 
the  expectoration  comes.  Respiration,  too,  is  often 
accompanied  by  a  dry  wheezing  sound,  and  by  an- 
other peculiar  one  which  has  been  denominated  the 
dry  mucous  rattle.  This  latter  appears  to  proceed 
from  the  upper  part  of  the  windpipe,  and  may  be 
distinctly  heard  at  a  considerable  distance.  It  has 
aptly  been  likened  to  the  ticking  of  a  watch,  and 
the  sound  of  a  click  wheel.  It  would  seem  as 
though  a  portion  of  concrete,  dry  mucus  yielded 
with  a  sudden  jerk  to  the  passage  of  the  air,  and 
thus  occasioned  this  clicking  noise.  It  is  almost 
always  present  at  some  period  of  the  disease,  usu- 


OF    CONSUMPTION.  71 

ally   in  its   advanced  stage,   and   is   more  or    less 
constant  in  different  cases. 

A  diarrhcEa,  often  the  result  of  tubercles  and 
ulcerations  of  the  bowels,  is  a  common  and  distress- 
ful attendant  of  the  last  stage  of  consumption,  and, 
in  union  with  the  night  sweats,  causes  a  rapid 
wasting  of  the  substance  and  powers  of  the  body, 
and  hurries  on  the  sufferer  to  his  grave.  Obstinate 
and  painful  constipation,  sometimes  alternates  with 
the  diarrhoea,  and  piles  or  hemorrhoids,  and  per- 
haps dysury  may  be  joined  to  the  other  afflictions. 

The  diarrhcea  comes  on  sooner  or  later  in  differ- 
ent cases.  Sometimes  happening  but  a  short  period 
before  death ;  and  in  rare  instances  it  has  not  oc- 
curred at  all.  It  now  and  then  supervenes  at  an 
early  period  of  the  disease,  existing  even  among 
its  first  indications,  and  continuing,  with  more  or 
less  urgency,  and  perhaps  occasional  remissions,  to 
its  termination.  It  has  accompanied  some  cases  of 
consumption  of  a  year's,  or  even  several  years'  du- 
ration, through  their  whole  course.  Those,  even, 
who  merely  labor  under  the  tuberculous  disposition, 
in  occasional  instances,  suffer  much  from  irritability 
of  the  bowels  and  diarrhoea,  ofttimes  alternating  with 
constipation,  and  frequently  exciting  hemorrhoids. 
Some  physicians  have  thought  that  consumptive 
subjects  are  especially  liable  to  fistula  in  ano ;  I 
have  often  witnessed  it  in  such,  but  that  they  are 
more  liable  to  the  affection  than  others  is  by  no 
means  confirmed. 


1-2 


CHAPTER  VI [. 

at.MPTo.Ms  or  THE  common  korm  (/F  thp:  disease  concluded. 

Last  period  and  termination  of  consumption.  As 
the  malady  draws  near  its  fatal  close,  the  most 
melancholy  phenomena  —  and  which  have  been  but 
too  truly  portrayed  from  the  time  of  Hippocrates  to 
the  present,  —  are  exhibited.  The  emaciation  is 
frightful,  and  the  most  mournful  change  is  witnessed 
in  the  whole  aspect.  A  few  months  have  deprived 
the  countenance  of  almost  every  trace  of  its  natural 
expression.  The  nose  is  sharpened,  nipped  in  ;  the 
cheeks  are  hollow,  the  cheek  bones  appear  unnat- 
urally prominent,  and  are  usually  reddened  by  a 
hectic  glow,  contrasting  strongly  with  the  ashy  pale- 
ness in  its  vicinity.  The  fat  of  the  face  being 
mostly  absorbed,  the  contraction  of  its  different 
muscles  is  witnessed  through  the  skin,  rendering 
the  expression  harsh  and  painful.  The  eyes  are 
commonly  sunken  in  their  sockets,  and,  from  the 
emaciation  about  them,  seem  enlarged,  and  often 
look  morbidly  bright  and  staring.  The  white  of 
the  eye,  being  almost  without  red  vessels,  displays 
frequently  a  remarkable  glistening  whiteness  shad- 
ing into  a  pearl  blue. 

The  lips  are  thin,  often  pale  and  retracted,  and, 
in  the  language  of  Laennec,  seem  to  express  a  bitter 
smile.     The  neck  appears  long  and  oblique,  and  the 


OF    CONSUMPTION.  73 

shoulder  blades  stand  off —  to  use  a  comparison  as 
old  as  Hippocrates,  —  like  the  wings  of  birds. 
The  ribs,  particularly  on  the  upper  and  fore  part  of 
the  chest,  become  unusually  distinct  and  prominent, 
owing  to  the  retraction  of  the  fleshy  spaces  between 
them.  The  chest  in  some  instances  —  probably  to 
adapt  itself  to  the  wasted  state  of  the  lungs,  —  be- 
comes generally  or  partially  contracted. 

The  belly  is  flattened  and  sunk.  The  various 
joints,  from  the  emaciation  about  them,  appear  en- 
larged and  unseemly ;  and  all  the  comeliness,  and 
pleasing  symmetry  of  the  human  form  are  destroyed, 
for  the  fat,  that  important  material,  which  gives  to 
the  limbs  their  roundness  and  nice  proportions,  and 
is  so  essential  to  the  harmony  of  our  whole  physical 
organization,  is  wasted  away. 

From  the  exposure  of  the  fingers,  their  appear- 
ance particularly  attracts  attention.  Their  joints 
seem  enlarged  and  disproportioned  by  contrast  vvith 
the  emaciated  interspaces;  their  extremities  be- 
come unnaturally  tapered,  and  the  nails,  losing 
their  support,  incurvate  like  the  claws  of  birds. 

The  pulse  all  the  while  is  extremely  frequent 
and  feeble,  and  the  voice  often  deep,  hollow,  pec- 
toral, its  tones  seeming  to  reverberate  in  the  chest. 

The  animal  functions,  that  is,  the  five  senses,  in- 
tellectual, moral,  and  muscular  powers,  do  not  par- 
ticipate in  the  disease  to  the  extent  that  might  be 
imagined.  A  deafness  sometimes  occurs,  but  it  is 
by  no  means  frequent. 
10 


74 


SYMPTOMS 


The  animal  muscles  often  retain  their  capabilities 
to  an  astonishing  degree,  when  we  consider  the  rav- 
ages that  are  going  on  in  organs  so  immediately 
essential  to  life  as  are  the  lungs.  Some  subjects, 
wasted  nearly  to  the  condition  of  a  skeleton,  their 
existence,  in  all  human  probability,  limited  to  the 
briefest  span,  are  still  capable  of  more  or  less 
bodily  exercise,  perhaps  of  daily  walking  some 
miles.  I  have  known  the  subjects  of  consumption 
to  walk  or  ride  abroad  even  to  the  day  of  their 
death.  But  if  the  individual,  either  on  account  of 
the  climate  in  which  he  dwells,  or  any  other  causes, 
is  abridged  of  his  requisite  exercise,  and  restrained 
within  the  limits  of  his  chamber,  his  muscular  pow- 
ers, partly  for  lack  of  use,  will  soon  fail. 

Amid  all  the  ravages  of  physical  disease  which  I 
have  endeavored  to  portray,  the  mind  often  remains 
comparatively  unharmed.  A  strange  illusion,  how- 
ever, remarkably  characteristic  of  consumption,  will 
not  unfrequently  retain  possession  of  it.  Thus  the 
sufferer  is  ofttimes  cheerful,  confident,  buoyed  up 
by  a  deceitful  hope,  when  the  disease  has  declared 
itself  to  all  about  him  in  language  that  cannot  be 
misunderstood.  Intellects  of  the  highest  order  have 
been  the  subjects  of  this  pleasing  deception.  Even 
distinguished  members  of  the  medical  profession, 
perfectly  familiar  with  the  disease,  and  who  could 
not  have  mistaken  it  in  another,  have,  themselves 
being  its  subjects,  become  entii-ely  blinded  in  regard 
to  its  nature,  and  yielding  to  this  peculiar  delusion, 


OF    CONSUMPTION.  75 

have  laid  plans  of  future  conduct,  and  reared  airy 
castles  of  future  enjoyment. 

I  think  I  cannot  better  exemplify  this  mental  de- 
ception under  which  consumptive  subjects  are  so 
apt  to  labor,  than  by  a  few  short  extracts  from  the 
life  of  Dr  Armstrong  —  a  highly  eminent  physician 
of  London,  and  whose  writings  have  been  much 
read  on  this  side  of  the  Atlantic,  —  who  fell  a  vic- 
tim to  the  disease  I  am  describing.* 

"  He  would  seldom  admit  to  those  about  him  that 
there  was  any  thing  serious  in  his  case,  and  he 
seemed  occasionally  to  have  almost  convinced  him- 
self that  he  labored  under  chronic  pleurisy."! 

The  following  quotation  is  from  a  letter  of  the 
brother  in  law  of'Dr  Armstrong,  to  Dr  Boott.  "  He 
[Dr  Armstrong]  told  me  after  you  were  gone  that 
he  was  quite  satisfied  both  yourself  and  Clark 
thought  his  case  hopeless,  and  that  he  saw  through 
your  evasions  of  his  questions  on  this  point,  but  that 
such  a  conclusion  was  by  no  means  warranted  by 
the  symptoms  and  circumstances  of  it.  In  short, 
he  seems  determined  to  recover,  in  order  to  confute 
you  both. "J     Even  when  his  disease  was  quite  far 

*  Memoir  of  the  life  and  medical  opinions  of  John  Armstrong,  M.  D. 
&c.,  with  an  inquiry  into  facts  connected  with  marsh  fever.  By  Francis 
Boott,  M.  D.  &c.,  in  two  volumes.  London.  This  work  not  only  does 
high  credit  to  the  talent  and  medical  acquirements  of  its  author,  who  was 
the  intimate  friend  of  Dr  Armstrong,  but  likewise  eminently  displays  that 
warmth  of  heart,  and  ardent  benevolence  of  feeling,  which  so  strongly 
mark  his  character,  and  which  he  e.xeinplifies  in  so  many  acts  of  disinter- 
ested kindness  toward  those  Americans  who  are  so  happy  as  to  form  his 
acquaintance  while  sojourning  in  London. 

tVol.  Lp.  79.  Ubid,  p.  81. 


76  SYMPTOMS 

advanced,  he  wi-ites  thus  in  a  note  to  Dr  Boott  — 
"  On  the  whole,  I  am  better,  and  determined  to  be 
quite  well  this  day  five  weeks."* 

Only  a  few  w^eeks  prior  to  his  death,  Dr  Arm- 
strong returned  to  London  from  the  country,  whither 
he  had  gone  for  the  improvement  of  his  health,  and 
again  entered  upon  the  active  duties  of  his  profes- 
sion. About  three  weeks  previous  to  his  dissolu- 
tion, he  hastily  summoned  Dr  Boott  in  a  state  of 
great  affliction,  under  the  false  idea  that  one  of  his 
ribs  was  fractured,  and  that  this  had  all  along  been 
the  cause  of  his  illness.  Soon  after  this,  he  took  to 
his  bed,  from  whence  he  never  more  arose. 

We  are  reminded  by  these  quotations,  of  another 
circumstance  worthy  of  note  in  the  disease  I  am 
treating,  viz.  that  its  subjects  are  often  disposed  to 
attribute  their  symptoms  to  some  accidental  affec- 
tion,—  in  short,  to  any  thing  rather  than  the  true 
cause,  seeming  unwilling  to  labor  under  even  the 
suspicion  of  so  deadly  a  malady.  Hence  at  one 
time  Dr  Armstrong  referred  all  his  symptoms  to 
chronic  pleurisy,  and  in  the  last  stage  of  his  disease 
to  a  fractured  rib. 

Consumption,  when  simple  and  established  in  the 
system,  as  a  general  rule,  appears  to  exercise  on 
the  brain  a  morbid  influence  inferior  to  that  of  dis- 
eases in  the  abdomen  even  of  a  much  less  serious 
character ;  this  important  organ  being  far  more  in- 
timately united  by  sympathetic  relations  with  the 
stomach,   liver,   &-c.,    than  with  the  lungs.     The 

*  Memoir,  p.  85. 


OF    CONSUMPTION.  77 

dyspeptic,  for  instance,  though  laboring  under  but 
slight  disease,  is  often  irritable,  glbomy,  and  very 
apprehensive  of  its  event.  If,  however,  the  con- 
sumptive subject  is  of  a  melancholic  temperament, 
and  his  malady  complicated  with  morbid  conditions 
of  the  stomach,  liver,  or  bowels,  the  mind  may  dis- 
play quite  a  different  cast  from  that  described. 

This  mental  illusion  referred  to,  may  be  protracted 
for  a  longer  or  shorter  period  in  different  instances. 
Almost  always,  however — sometimes  suddenly, 
and  but  little  before  death,  —  the  individual  is 
awakened  from  it ;  new  light  seems  to  burst  upon 
his  mental  vision ;  he  becomes  aware  of  his  ap- 
proaching dissolution,  and  often  with  an  astonishing 
calmness  and  clearness  of  mind,  prepares  himself 
for  the  solemn  event.  A  short  period  previous  to 
his  death,  Dr  Armstrong  became  perfectly  conscious 
of  the  nature  of  his  disease,  spoke  freely  of  its 
termination,  and  with  composure  and  resignation 
communicated  his  last  wishes  to  his  friends. 

My  mind  here  cannot  but  revert  to  the  case  of  a 
much  esteemed  medical  friend  and  associate,*  who 
recently  fell  a  victim  to  the  malady  I  am  describing. 
This  gentleman  formed  an  interesting  illustration 
of  the  beautiful  moral  character  which  is  some- 
times seen  miited  with  the  tuberculous  predis- 
position.    But  different  from  what  happened  in  the 

"Benjamin  Lincoln,  M.  D.,  Professor  of  Anatomy  and  Physiology  at  the 
Medical  School  of  the  University  of  Vermont.  Formerly  Lecturer  on 
Anatomy  in  the  University  of  Maryland,  at  Baltimore,  and  in  the  3Iedical 
School  of  Bowdoin  College. 


78  SYMPTOMS 

instance  ot'Dr  Armstron<2j,  the  delusion  in  regard  to 
tlie  nature  of"  his  comphunt,  though  existing  at  first, 
was  not  lasting.  During  almost  a  year  prior  to  dis- 
solution, he  was  perfectly  convinced  of  the  existence 
of  tubercles  in  his  lungs,  and  his  mind  was  fully 
prepared  for  their  fatal  result. 

The  temperament  of  this  gentleman  was  sanguine, 
his  complexion  light,  and  apt  to  become  a  little 
flushed  under  excitement.  His  eye  mild  and  bright, 
quickly  lighting  up  when  his  feelings  became  inter- 
ested, and  his  whole  countenance  beamed  with 
intelligence,  and  was  ever  varying  to  express  the 
amiable  affections  of  his  heart. 

His  high  moral  susceptibility,  and  the  intense 
interest  afforded  him  by  all  his  pursuits,  and  more 
especially  those  of  an  intellectual  character,  gave 
to  his  life  a  continued  pleasurable  excitement,  which 
even  pain — his  almost  constant  attendant,  —  could 
not  suppress. 

One  of  the  most  interesting  and  beautiful  traits 
in  his  character — and  the  more  so  from  its  rareness, 
— was  his  active  benevolence.  No  labor,  no  per- 
sonal sacrifice  appeared  too  great,  would  it  but 
enhance  the  happiness  of  others.  This  devotion  of 
self  to  the  benefit  of  those  about  him,  was  almost 
carried  to  a  fault,  and  I  doubt  not  had  some  concern 
in  the  early  development  of  the  disease  to  which  he 
fell  a  victim.  The  ardor  and  enthusiasm  which  he 
manifested  in  all  his  pursuits,  was  truly  astonishing. 
A  sort  of  instinct  seemed  to  urge  him  on  to  make 
the  most  of  the  short  life  which   in   the  plans  of 


OF    CONSUMPTION.  79 

nature  was  allotted  to  him;  and  few,  I  am  con- 
vinced, have  ever  experienced  so  much  enjoyment 
in  so  brief  a  space.  It  seemed,  in  truth,  almost 
impossible  for  him  to  be  unhappy. 

His  friends  well  know  how  ardent  was  his  love 
for  science,  and  with  what  zeal  and  success  he  pros- 
ecuted it.  And  the  public  stations  to  which  he  w^as 
invited,  and  the  satisfaction  he  gave  in  them,  em- 
inently evinced  both  his  talent  and  acquirements. 

The  subject  of  this  case  possessed  a  strong,  deep 
and  sonorous  voice,  and  believed  himself  endowed 
with  a  remarkable  immunity  from  pulmonary  com- 
plaints, and  would  often  allude  with  much  satisfaction 
to  the  imagined  health  and  vigor  of  his  lungs.  For 
many  years  he  was  the  almost  constant  subject  of 
pain,  often  quite  severe,  and  which  was  referred  to 
rheumatism. 

During  the  period  of  one  of  his  courses  of  lectures, 
soon  after  retiring  to  bed,  he  was  suddenly,  and 
without  any  striking  premonitory  signs,  attacked  by 
a  hemorrhage  from  the  lungs.  About  a  teacupful 
of  pure  frothy  blood  was  discharged,  leaving  him 
perfectly  easy,  with  but  trifling  exhaustion,  though 
greatly  astonished  at  the  unlooked-for  invasion.  A 
careful  examination  of  the  chest  was  now  made,  by 
means  of  the  stethoscope  and  percussion,  which  led 
to  the  suspicion — for  the  first  time  entertained, — 
of  the  existence  of  tubercles  in  the  upper  portion  of 
the  right  lung.  Such,  however,  was  his  enthusiasm 
of  character,  and  his  strong  sense  of  duty  to  his 
class,  that  the  strictest  injunctions  only,  could  re- 


80 


SYMPTOMS 


Strain  liini   from   his  lecture-room  on  the  ensuing 
day. 

At  the  end  of  three  days,  he  again  entered  upon 
his  duties,  delivering  two,  and  sometimes  three 
lectures  a  day.  In  a  short  period,  a  second,  though 
slighter  hemorrhage  occurred,  but  which  he  would 
not  allow  to  confine  him  a  single  day  from  his  ardu- 
ous engagements.  His  health  now — though  he  had 
no  subsequent  attack  of  hemoptysis, — depreciated 
gradually,  and  in  a  little  more  than  a  year,  during 
which  time,  though  in  the  most  infirm  condition,  he 
delivered  another  eloquent  and  laborious  course  of 
lectures,  he  was  compelled  to  abandon  his  profes- 
sional duties,  and  seek  in  the  bosom  of  his  home 
those  attentions  and  consolations  which  his  declining 
health  required.  In  a  little  time,  all  doubts  which 
had  heretofore  existed  in  regard  to  the  nature  of  his 
complaint  were  removed  from  his  mind,  and  he 
calmly  resigned  himself  to  his  fate.  He  suffered 
but  little  from  his  disease,  and  w^ith  a  grateful  heart, 
and  sensibility  peculiar  to  his  character,  enjoyed  the 
kindness  of  friends,  and  those  pure  comforts  which 
the  sick  man  can  find  no  where  but  in  the  peaceful 
haven  of  his  home.  In  a  letter  written  a  few  months 
previous  to  his  death,  he  expresses  himself  thus : — 
"There  can  be  no  doubt  that  I  am  laboring  under 
confirmed  phthisis ;  but  its  advances  are  slow.  I 
suffer  comparatively  very  little,  have  nothing  like 
hectic,  although  much  emaciated  and  quite  weak. 
No  man  was  ever  so  well  provided  for  with  all  the 
comforts  of  home  as  I  am.     0  !  what  madness  to  go 


OF    CONSUMPTION.  81 

away  from  home  to  die!"  In  a  letter  of  a  little 
later  date,  he  says — "I  suffer  almost  nothing,  am 
quiet  and  happy."  He  died  at  the  age  of  thirty- 
two. 

Different  phenomena  and  degrees  of  suffering 
mark  the  termination  of  consumption.  In  some 
instances,  life,  wasted  to  the  most  feeble  spark, 
goes  out  almost  insensibly.  Again,  dissolution  is 
preceded  by  more  or  less  painful  and  exhausting 
symptoms,  as  excessive  sweats  and  diarrhoea,  often 
involuntary,  and  at  times  attended  with  colic  pains. 
Or  the  powers  of  the  system  may  have  become  so 
reduced,  that  expectoration  can  no  longer  be  carried 
on,  to  free  the  lungs  of  the  matters  accumulated  in 
them.  Or  a  mass  of  softened  tuberculous  matter 
may  suddenly  flow  into  the  air-cells  and  air-tubes 
of  the  lungs,  causing  speedy  suffocation.  Or  slight 
hemorrhages  may  occur,  gradually  wasting  the  little 
strength  that  remains,  or  terminating,  after  awhile, 
in  a  gush  of  blood-  from  the  lungs,  so  copious  that 
life  immediately  yields.  Sometimes,  a  profuse  he- 
morrhage comes  on  at  once,  pouring  from  the  mouth 
and  nostrils,  and  causing  almost  instant  suffocation. 

The  hemorrhages  occurring  in  the  last  stage  of 
consumption,  are  probably,  in  most  instances,  refer- 
rible  to  a  rupture  of  the  coats — previously  thinned 
by  ulceration,  or  weakened  by  the  disease,  —  of  one 
or  more  blood-vessels  in  the  lungs. 

For  a  short  time  prior  to  dissolution,  the  cough 
and  expectoration  diminish,  and  frequently,  almost 
or  wholly  cease ;  this  may  be  owing  to  a  diminution 
11 


82 


SV,\1P'1U,^IS 


ol"  nervous  .sensibility,  the  necessary  consequence  of 
exhausted  vitality,  and  is  commonly  viewed  as  a 
harbini^er  of  speedy  death. 

In  the  latter  period  of  consumption,  a  dropsical 
swelling  of  the  feet  and  ancles  is  frequently  observed; 
and  occasionally  such  effusions  happen  in  other 
situations,  yet  they  occur  here  less  early,  and  are 
more  usually  conhned  to  the  inferior  })ortion  of  the 
lower  extremities,  than  in  most  other  fatal  organic 
diseases. 

A  low  delirium  may  come  on  toward  the  close  of 
life;  yet  in  the  majority  of  instances,  the  mind 
maintains  its  integrity  to  the  last. 

Circumstances  injiuencing  the  progress  and  phenomena 
of  the  disease.  —  Consumption,  like  every  other 
malady,  is  liable  to  be  more  or  less  influenced  in 
its  phenomena  and  progress  by  fortuitous  circum- 
stances. If  the  system  is  deeply  imbued  with  a 
tuberculous  taint,  the  disease,  other  things  being 
equal,  will  be  more  perfectly  developed,  and  its 
advance  will  be  more  regular,  and  suffer  less  inter- 
ruption than  in  a  constitution  more  faintly  impressed 
with  the  consumptive  predisposition.  If  the  indi- 
vidual dwells  in  a  cold  and  variable  climate,  and  is 
consequently  restrained  within  doors,  and  abridged 
of  his  needed  exercise,  the  vital  energies  will  more 
quickly  decline,  and  the  disease  proceed  more 
rapidly,  than  under  softer  and  more  equable  skies, 
where  he  can  daily  exercise  his  limbs  abroad,  and 
inhale  the  fresh  air  of  heaven. 

Extremes  either  of  heat  or  cold,  always  hurry 
forward  the  disease  when  once  established. 


OF    CONSUTirPTTON.  83 

If  the  subject  is  intemperate,  and  irregular  in  his 
habits  of  life,  or  his  mind  ill  at  ease,  his  malady  will 
be  accelerated  in  its  march,  and  the  suffering  aggra- 
vated ;  and  on  the  other  hand,  its  progress  may  be 
retarded,  and  its  symptoms  alleviated  by  a  due 
attention  to  diet  and  regimen,  and  a  judicious-  med- 
ical treatment. 

Pregnancy,  when  happening  early  in  consumption, 
will  frequently  occasion  a  remarkable  interruption 
of  its  symptoms,  the  cause  often  of  flattering  hopes 
which  must  end  in  sad  disappointment.  The  female 
not  uncommonly  passes  through  her  full  period  of 
gestation,  her  labor  is  probably  natural,  and  often 
easy,  and  followed,  perhaps,  by  a  free  flow  of  milk. 
Soon,  however,  the  secretion  of  this  fluid  lessens, 
and  ere  long  ceases  altogether.  The  cough,  with 
all  the  other  melancholy  symptoms  now  return,  and 
the  disease  runs  on,  with  an  impetus  seemingly 
augmented  by  rest,  to  its  fatal  conclusion. 

If  conception  happens  —  as  is  sometimes  the  case, 
—  in  the  advanced  stage  of  consumption,  the  labor 
will  usually  come  on  before  its  natural  period,  and 
death  may  occur  during  or  immediately  after  it,  — 
or  if  life  does  not  yield  at  this  time,  it  will  probably 
be  of  but  brief  continuance. 

When  the  tuberculous  predisposition  is  very 
strong,  pregnancy  may  act  as  an  occasional  cause 
to  arouse  it  into  action.  Hence  it  is  that  frail, 
scrofulous  young  females  not  uncommonly  fall  into 
consumption  soon  after  the  birth  of  their  first  child. 


84 


CHAPTER  V[1I. 

VARIETIES    OF    CONSUMPTION ACUTK CHRONIC  —  LATKNT. 

RECAPITULATION    OF     SOME     OF     ITS     CHARACTERISTIC     SYMP- 
TOMS. 

Acute  variety.  —  Consumption,  in  occasional  in- 
stances, is  very  acute,  running  its  course  with  great 
celerity.  Such  is  sometimes  observed  to  be  the 
case  where  it  immediately  succeeds  to  common 
fever,  scarlet  fever,  measles,  or  to  other  influences 
acting  forcibly  in  the  development  of  a  tuberculous 
disposition.  Its  most  frequent  subjects  are  young 
persons,  and  those  whose  systems  are  deeply  im- 
bued with  the  scrofulous  taint.  Dr  Clark  very 
rightly  asserts  that  the  short  course  of  the  disease, 
is  in  some  cases  more  apparent  than  real.  "The 
tuberculous  disease  of  the  lungs,  though  latent,  has 
been  making  silent  progress,  until,  from  exposure 
to  cold,  or  violent  exertion,  an  attack  of  catarrh,  of 
pneumonia,  or  of  hemoptysis  is  induced :  after  which 
the  usual  symptoms  show  themselves,  and,  owing 
to  the  extent  of  the  tuberculous  deposit,  the  disease 
proceeds  in  its  course  with  unusual  rapidity." 

In  this  acute  variety,  there  appears  to  be  a  very 
rapid  and  extensive  development  of  tuberculous  dis- 
ease in  the  lungs,  attended,  no  doubt,  for  the  most 
part,  with  more  or  less  common  inflammation.  The 
symptoms  come  on  suddenly  and  violently,  perhaps 


VARIETIES    OF    CONSUMPTION.  85 

after  the  individual  had  been  complaining  for  some 
time,  though  without  evincing  any  distinct  signs  of 
consumption.  The  hectic  fever  is  acute ;  the  ema- 
ciation proceeds  rapidly,  and  the  disease  hurries 
through  its  different  changes  with  a  frightful  speed, 
terminating  often  in  from  six  to  ten  wrecks,  and  in 
rare  cases,  death  has  happened  in  three  w'eeks. 
Such  instances  are  commonly  and  very  aptly  termed 
galloping  consumption.  In  some  parts  of  the  south 
of  France,  as  Marseilles,  the  disease  often  runs  its 
course  very  rapidly,  and  with  very  acute  symptoms. 

In  some  delicate,  weakly  and  highly  tuberculous 
subjects,  the  disease  proceeds  very  swiftly,  life 
yielding  even  in  the  course  of  several  weeks,  although 
the  symptoms  may  never  be  very  severe,  or  strongly 
manifested.  Here  the  vital  or  reacting  powers  are 
inadequate  to  give  a  bold  relief  to  the  symptoms,  or 
to  maintain  a  long  struggle  against  the  influence  of 
the  disease.  Such  individuals  seem  as  frail  as  the 
leaves  of  autumn,  and  fall  almost  as  readily.  They 
are  often  peacefully  sinking  into  the  arms  of  death, 
before  their  danger  is  even  suspected. 

Chronic  consumption.  —  Consumption,  in  strictness 
of  language,  may  in  the  majority  of  instances  be 
called  chronic,  yet  we  use  the  term  to  designate 
especially  such  cases  as  are  very  tardy,  and  liable 
to  interruptions  in  their  course. 

The  symptoms  in  this  variety  are  apt  to  come  on 
slowly  and  insidiously  at  first ;  also,  at  a  later  period 
of  life  —  frequently  after  the  fortieth  year,  —  than  in 
the    more    ordinary  form   of  the  disease;    and   to 


86  Cin^OMC    CONSUMPTION. 

appear  in  constitutions   in  which   the  consumptive 
predisposition  is  not  very  forcibly  portrayed. 

Its  subjects  are  constantly  infirm,  and  although 
they  may  be  able,  with  occasional  interruptions,  to 
prosecute  their  ordinary  avocations,  yet  it  is  with 
far  less  alacrity,  both  mental  and  physical,  than 
heretofore.  They  grow  pale  and  thin,  and  though 
the  appetite  may  often  be  good,  they  rarely  regain 
their  flesh.  They  are  liable  to  dyspepsia,  and 
sometimes  to  diarrhoea.  The  cough,  from  which 
they  are  seldom  wholly  free,  is  much  aggravated 
during  the  winter  season,  or  whenever  the  weather 
becomes  damp  and  variable,  resembling  that  of  a 
common  catarrh,  to  which  they  are  believed  to  be 
very  subject;  they  endure,  therefore,  but  little 
exposure.  They  are  short-breathed,  and  bear  but 
trifling  fatigue ;  and  are  ever  compelled  to  be  scru- 
pulously regardful  of  their  health,  for  which  reason 
they  are  apt  to  be  ranked  among  that  unhappy  class 
of  individuals,  who  receive  so  little  sympathy  from 
their  fellow  mortals,  called  valetudinarians. 

The  aggravations  and  pauses  in  chronic  consump- 
tion are  more  or  less  frequent  and  distinct  in  different 
cases ;  the  former  being  far  more  common  in  the 
cold,  the  latter  in  the  summer  months.  Hence  the 
sufferer  will  often  appear  to  be  fast  approaching  the 
goal  of  his  being,  his  fate  is  even  pronounced,  when 
unexpectedly  to  all,  the  threatening  symptoms  abate, 
his  health  rapidly  grows  better,  and  thus,  for  the 
time  being,  he  disproves  the  prediction  both  of 
physician  and  friends. 


LATENT    CONSUMPTION,  87 

Life  here  is  always  extremely  precarious ;  the 
disease  being  in  continual  danger  of  aggravation 
from  the  action  of  various  incidental  causes.  The 
supervention  of  influenza,  lung  fever,  pleurisy, 
common  fever,  &c.,  will  ever  place  life  in  the 
greatest  jeopardy. 

It  is  in  these  tardy  cases  of  consumption,  and  in 
a  particular  manner  during  the  interruption  of  their 
symptoms,  that  a  mild  climate,  and  a  judicious 
regard  to  diet  and  regimen,  often  exercise  a  marked 
and  happy  influence. 

Chronic  phthisis  may  continue  for  several  years, 
subject  to  pauses  in  its  course,  of  longer  or  shorter 
duration.  Instances  are  even  recorded  where  it 
has  lasted  for  forty  years.  Louis  has  given  us  cases 
of  ten,  twelve,  fourteen,  and  twenty  years'  dura- 
tion.* 

In  such  protracted  states  of  the  disease,  there 
probably  happen  successive  eruptions  of  tubercles, 
but  not  sufliciently  numerous  at  any  one  time  to 
destroy  life.  Laennec  asserts  it  to  be  in  the  subjects 
of  such  chronic  cases,  that  cicatrices  are  most  com- 
monly discovered  in  the  lungs  after  death. 

Latent  consumption.  —  The  characteristic  features 
of  consumption  are  not  always  clearly  manifest. 
Some,  or  nearly  all  its  important  and  distinguishing 
symptoms  may  occasionally  be  wanting,  and  yet  the 
malady  be  surely,  though  insidiously,  advancing. 
The  subject  is  in  ill  health,  is  feeble,  his  flesh  is 

*  llecherchcs  sur  la  riithisie,  p.  183. 


88  LATKNT    CONSUMPTION. 

wastins;,  yet  the  thought  of  consumption  is  far  from 
his  mind.  But  such  symptoms,  especially  occurring 
in  a  scrofulous  constitution,  should  awaken  serious 
apprehension,  and  the  lungs  be  forthwith  subjected 
to  the  most  careful  medical  examination,  since  every 
thing  depends  on  the  detection  of  the  first  invasion 
of  the  disease. 

The  malady  under  consideration  may  likewise  be 
obscured  and  rendered  latent  by  a  complication  with 
other  morbid  affections.  A  diarrhoea,  for  example, 
occurs  in  a  tuberculous  subject,  and  continuing  in  a 
more  or  less  aggravated  degree,  all  attention  is 
diverted  to  it,  and  cough  and  expectoration  being 
absent,  or  so  trifling  as  hardly  to  excite  observation, 
not  the  slightest  suspicion  of  consumption  is  enter- 
tained. The  strength  and  flesh,  however,  waste 
rapidly  under  its  influence,  life  ultimately  yields, 
and  the  lungs  are  found  crow^ded  with  tubercles, 
for  the  most  part  in  a  crude  state.  Here,  if  I  may 
so  express  it,  the  diarrhcea  seemed  to  swallow  up, 
or  concentrate  within  itself,  all  diseased  action. 
Such  cases  must  have  fallen  under  the  observation 
of  most  physicians,  and  may  be  found  alluded  to  by 
certain  medical  writers.  Thus  Laennec  tells  us 
that  some  instances  of  phthisis  beginning  with 
diarrhoea,  prove  fatal  without  being  attended  either 
by  cough  or  expectoration,  and  that  here  crude 
tubercles  are  usually  found  in  the  lungs. 

Insanity  and  hypochondriasis  supervening  to  con- 
sumption, may  obscure  its  phenomena,  and  perhaps 
for  a  time  interrupt  its  course.     The  disease,  how- 


LATENT    CONSUMPTION.  89 

ever,  still  exists,  and  life  will  probably  sooner  or 
later  yield  to  its  influence. 

When  consumption  happens  in  the  course  of,  or 
becomes  complicated  with,  certain  chronic  diseases, 
as  liver  complaints,  old  agues,  scurvy,  &lc.,  its  phe- 
nomena are  often  so  blended  with,  and  modified  by, 
those  of  the  other  morbid  affection,  that  the  most 
careful  scrutiny  is  demanded  to  separate  them. 
Dyspepsia,  especially,  when  existing  simultaneously, 
and  its  symptoms  being  the  most  prominent,  will 
not  unfrequently  divert  all  attention  to  itself;  and 
it  is  only,  perhaps  a  short  period  before  death,  that 
the  great  emaciation,  in  combination  with  other 
symptoms,  proclaim  the  hopeless  disease  that  has 
been  going  on  in  the  lungs.  Obstinate  dyspepsia 
existing  in  a  suspected  tuberculous  habit,  and 
accompanied  with  much  emaciation  —  even  though 
cough  and  other  characteristic  signs  of  pulmonary 
tubercles  be  absent — should  still  awaken  fearful 
apprehensions,  and  the  chest  forthwith  be  submitted 
to  a  cautious  examination. 

Very  many  of  our  common  consumptive  cases, 
are  unquestionably  latent  at  their  commencement, 
being  referred  to  slight  colds  or  affections  of  the 
stomach.  In  by  far  the  greater  proportion,  however, 
even  of  latent  instances  of  the  disease,  the  symptoms 
become  sufficiently  manifest  at  some  period  before 
death. 

Consumption  may  be  obscured,  particularly  in  its 

early  stage,  by  ulceration  of  the  larynx,  or  superior 

portjon  of  the  wind  pipe,  and  the  epiglottis,  or  valve 
1-2 


90  RECAPITULATION    OF 

which  guards  its  entrance ;  an  affection  to  which  I 
have  before  made  allusion.  Here  the  earliest  man- 
ifest signs  are  irritation  in  the  throat,  causing  a 
frequent  hawking,  difliculty  of  speaking  and  swal- 
lowing, pain  about  the  top  of  the  windpipe,  especially 
on  pressure,  and  emaciation.  The  subject,  and 
usually  his  friends,  are  disposed  to  look  to  the  throat 
as  the  scat  of  the  whole  disease,  and  to  imagine  that 
health  would  return,  could  the  trouble  existing  there 
be  removed.  But  there  is  a  deeper  seated  difficulty, 
for  tuberculous  disease,  and  often  very  extensive,  is 
commonly  all  the  while  rapidly  advancing  in  the 
lungs.  Andral  asserts  that  the  larynx  is  rarely  if 
ever  found  in  a  state  of  ulceration,  unless  there  are 
at  the  same  time  tubercles  in  the  lungs.  Such 
cases  are  denominated  laryngeal.  The  ulcers 
found  in  the  larynx  are  often  of  a  strictly  tuberculous 
character. 

I  will  now  conclude  the  symptoms  of  consump- 
tion by  repeating  a  few  of  its  early  phenomena, 
which,  when  seen  in  combination,  should  ever 
awaken  our  most  lively  solicitude. 

Some  little  oppression  and  embarrassment  of  the 
breathing,  scarcely  observable,  perhaps,  when  the 
individual  is  calm  and  at  rest,  but  becoming  very 
manifest  during  exercise — especially  on  ascending 
an  elevation — and  under  the  influence  of  vivid 
emotions.  A  slight,  though  pestering  cough,  not 
yielding,  like  ordinary  catarrhal  coughs,  to  common 
expectorant  medicines.  It  may  be  dry,  but  is  more 
usually  attended  with  the  expectoration  of  a  some» 


SYMPTOMS.  91 

what  viscid,  frothy  fluid.  It  is  also  apt  to  be 
aggravated  in  a  measure  by  the  horizontal  posture, 
or  a  sudden  change  of  position,  as  on  going  to,  or 
rising  from  bed.  Pain  somewhere  about  the  chest, 
in  the  majority  of  cases  not  strongly  marked,  and 
in  some  detected  only  at  the  latter  period  of  a  deep 
inspiration.  It  may  be  either  stationary  or  wander- 
ing. Unnatural  and  irregular  heat  of  the  surface  of 
the  body.  Burning  of  the  hands  and  feet,  more 
particularly  toward  evening,  and  at  night,  often 
alternating  with  coldness.  Pulse  uniformly  a  little 
increased  in  frequency,  sometimes  accompanied  with 
a  slight  hardness,  and  very  readily  accelerated  on 
exercise,  or  sudden  emotion.  A  sense  of  lassitude, 
occasioning  an  indisposition  either  to  moral  or  phys- 
ical labor.  A  gradual  failure  of  strength  and  loss 
of  flesh,  perhaps  even  when  the  appetite  is  sufl[icient, 
and  the  digestive  powers  not  materially  injured. 
And,  furthermore,  if  the  subject,  in  union  with  such 
symptoms,  exhibits  the  constitutional  peculiarities 
commonly  associated  with  a  tendency  to  the  disease, 
and  has  derived  his  being  from  consumptive  parents 
or  ancestors,  scarcely  a  rational  hope  can  be  indulged 
in  his  favor.  The  disease  may  pause  in  its  progress, 
and  thus  life  be  protracted,  and  flattering  expecta- 
tions encouraged,  but  it  is  ultimately  sure  of  its 
victim. 


92 


CHAPTER  IX. 

CAUSES    OF    CO.VSUMl'TIO.N,    AM)    MEANS    OK    PRKVEXTIf.N. 

Predisposing  and  occasional  causes.  —  The  causes 
of  consumption,  as  also  of  most  other  diseases,  are 
generally  divided  into  two  sets — the  predisposing, 
and  occasional   or   exciting.     The  former  tend  to 
induce    that    mysterious    condition    of   the    animal 
economy,  or   individual  parts,, in  which  they  take 
on  with  great  facility  particular  kinds  of  diseased 
action,  and  which  constitutes  what  we  term  a  pre- 
disposition to  disease.    It  is  often  innate  and  derived, 
its  causes  acting  on  the  offspring  through  the  con- 
stitution of  the  parent.     The  latter,  or  occasional 
causes,  serve  to  call  into  action  diseases  to  which 
a  tendency  already  exists,  from  the  influence  which 
has  been  exercised  by  the  predisposing  causes.     To 
illustrate — if  several  persons  were   suddenly  sub- 
jected to  the  impression  of  a  cold,  damp  atmosphere, 
though  disease  might  be  generated  in  all,  yet  per- 
haps no  two  would  be  affected  alike.     One  might 
have  rheumatism ;   another,  gout ;   another,  erysip- 
elas ;   another,  pulmonary  disease,  &c.     Here,  the 
sudden   exposure   is   the    immediate  or  occasional 
cause  of  diseased  action  in  each,  but  the  peculiar 
character  of  the  disease  is  believed  to  be  determined 
by  the  other  or  predisposing  causes.     With  a  solu- 
tion  of  muriate  of  cobalt,  or  sympathetic  ink,  w^e 


CAUSES    OF    CONSUMPTION.  93 

may  trace  on  paper  figures  of  various  descriptions, 
as  men,  horses,  birds,  trees,  &.C.,  which  shall  be 
perfectly  invisible  when  cold,  but  bring  them  near 
the  fire,  and  they  all  immediately  become  apparent 
to  the  view.  Now  the  heat  had  no  concern  in  the 
formation  of  these  different  figures,  but  simply  in 
rendering  them  visible.  Just  so  with  exciting  causes, 
they  may  often  have  little  to  do  in  giving  distinctive 
character  to  the  disease;  but  like  the  fire,  in  its 
action  on  the  invisible  ink,  call  into  sensible  exist- 
ence those,  which,  if  I  may  so  speak,  are  already 
sketched  out  in  the  constitution. 

It  is  well  known  that  certain  seasons  and  climates 
act  as  predisposing  causes  of  particular  diseases. 
Thus  it  is  that  exposure,  improper  diet,  and  other 
occasional  causes,  may  sometimes  excite  dysentery, 
at  others  fevers,  inflammation  of  the  lungs,  &:c. 

When  an  individual  is  constitutionally  inclined  to 
consumption,  all  causes  which  derange  the  health, 
or  act  injuriously  on  the  lungs,  or,  in  short,  every 
thing  that  tends  to  develop  the  disease,  is  called  an 
occasional  cause.  We  here  distinguish  but  one  set 
of  causes,  the  other  having  already  accomplished 
their  mysterious  work  in  the  economy.  But  when 
this  predisposition  is  not  marked,  then,  to  give  indi- 
viduality to  the  disease,  the  agency  of  predisposing 
causes  is  believed  to  be  necessary. 

Though  I  have  thought  it  proper  to  explain  this 
distinction  usually  made  between  the  causes  of  dis- 
ease, yet  it  must  be  acknowledged,  that  practically 
it  is  often  attended  with  much  difficulty.     The  two 


94 


CAUSES    AND    PREVENTION 


sets  of  causes  will  not  unfrequently  be  so  confounded 
with  each  other,  that  no  accurate  line  can  be  run 
between  them.  The  predisposing,  too,  may  act  at 
the  same  time  as  exciting  causes,  their  impulse 
being  sufficient  both  to  determine  the  disease,  and  to 
quicken  it  into  active  existence.  And  furthermore, 
what  we  ordinarily  denominate  occasional,  may, 
under  some  circumstances,  operate  as  predisposing 
causes.  In  the  ensuing  examination,  therefore,  of 
the  causes  of  consumption,  I  shall  not  attempt  to 
keep  in  view  any  nice  distinction  between  the  two 
sets  to  which  I  have  alluded. 

Hereditary  origin  of  a  consumptive  predisposition.  — 
The  transmission  from  parents  to  their  offspring  of 
particular  conditions  of  organic  structure,  associated 
w^ith  a  facility  in  the  production  of  certain  diseases, 
as  consumption,  gout,  insanity,  and  probably  a  host 
of  others,  is  now  undisputed  in  medical  science. 

Sometimes  physical  traits  marking  the  morbid 
tendency,  are  declared  in  the  complexion,  external 
conformation,  &c.,  as  I  have  stated  often  to  be  the 
case  in  consumption.  In  the  greater  proportion  of 
instances,  however,  such  tendency  is  dependent  on 
modifications  of  the  physical  constitution  not  appre- 
ciable by  our  senses.  But  the  importance  of  the 
subject  will,  I  trust,  excuse  me  for  introducing  here 
a  few  remarks  of  a  somewhat  general  character  on 
the  transmission  of  hereditary  peculiarities.* 

"  On  this  subject  much  valuable  information  m  ly  be  found  in  Mr  Law- 
rence's Lectures  on  Phjsiology,  Zoology,  and  the  Natural  History  of  Man- 
Also,  in  Mr  Combe's  work  on  the  Constitution  of  Man,  and  Spurzheim's 
on  Education. 


OF    CONSUMPTION.  95 

It  is  a  familiar  fact  that  children  commonly  inherit 
in  a  greater  or  less  degree,  the  looks  and  the  gen- 
eral constitution  of  their  parents ;  sometimes  espe- 
cially of  the  father,  sometimes  of  the  mother ;  or 
the  moral  and  physical  characters  of  both  parents 
may  be  blended  in  the  offspring.  Which  exercises 
the  greater  influence  upon  the  progeny,  male  or 
female,  is  yet  a  matter  in  dispute ;  but  that  it  varies 
in  different  cases,  is  sufficiently  obvious.  Thus,  we 
obser\  e  in  some  families  that  almost  all  the  children 
closely  resemble  the  father ;  whereas,  in  others,  the 
mother  seems  to  be  the  type  upon  which  they  are 
especially  formed. 

In  occasional  instances,  children  will  partake 
more  of  the  looks  and  general  constitution  of  their 
grandparents,  or  some  of  their  ancestors,  than  those 
of  their  parents.  Thus  morbid  predispositions  will 
now  and  then  appear  to  skip  over,  or  at  least  to  lie 
dormant  in  one  generation,  and  then  declare  them- 
selves with  their  original  vigor  in  the  next.  A 
consumptive  constitution,  therefore,  may  be  hered- 
itary in  an  individual,  though  it  was  never  displayed 
in  his  parents.  That  such  things  are,  we  know; 
but  why  or  how,  philosophy  has  failed  to  teach  us. 

Certain  accidents,  as  they  are  commonly  styled, 
are  well  known  to  be  transmitted  in  families  for 
very  long  periods.  "The  thick  lip  introduced  into 
the  imperial  house  of  Austria  by  the  marriage  of  the 
emperor  Maximilian  with  Mary  of  Burgundy,  is 
visible  in  their  descendents  to  this  day,  after  a  lapse 


96  CAUSES 

of  three  centuries."*  The  English  porcupine  family 
form,  also,  an  illustration  of  this  power  of  trans- 
mitting constitutional  peculiarities.  They  derived 
this  name  from  the  circumstance  of  the  greater  part 
of  their  bodies  being  covered  by  dark  colored  warty  or 
horny  excrescences,  an  inch  in  height  when  at  their 
full  size.  They  Avere  shed  annually  in  the  winter 
or  autumn,  and  succeeded  by  a  new  growth  of  the 
same  substance.  The  first  porcupine  man  had  six 
children,  all  with  the  same  rough  covering,  which 
came  on  in  them  about  nine  weeks  after  birth. 
This  same  condition  of  the  skin  was  also  seen  in 
some  of  the  grandchildren. 

That  peculiar  variety  of  the  human  race  termed 
the  Albino  is  also  propagated  in  certain  families. 
More  or  less  of  the  members  of  some  families  have 
for  ages  been  marked  by  supernumerary  fingers  or 
toes,  or  perhaps  both.  Now  suppose  individuals 
possessing  a  like  innate  peculiarity,  as  six  fingers 
or  toes,  or  any  other  malformation  of  exactly  the 
same  character,  to  intermarry,  such  A't'ould  in  all 
probability  be  perpetuated  in  their  offspring.  If  the 
peculiarity  belonged  to  only  one  of  the  parents, 
some  of  the  children  might  inherit  it,  while  it  was 
absent  in  others.  An  interesting  fact  in  point  was 
related  to  me  a  few  years  since  by  Mr  (now  Pro- 
fessor) Zerah  Colburn,  the  gentleman  w^ho  was  so 
extensively  known  in  early  life  for  his  extraordinary 
powers   of  calculation.     One    of  his   parents    (his 

*  Lawrence  on  Pbysiology,  Zoology,  and  the  NaturaJ  History  of  Maa. 


OF    CONSUMPTION.  07 

fother)  had  a  supernumerary  finger  and  toe  on  each 
hand  and  foot,  Avhich  malformation  he  inherited, 
being  born  with  six  fmgers  on  his  upper,  and  six  toes 
on  his  lower  extremities.  Some  of  his  brothers  dis- 
played the  same  peculiarity,  others  not.  The  extra 
fingers  were  cut  off  in  infancy.  The  lady  whom  he 
married  was  a  distant  connexion  of  his  own,  and  in- 
herited exactly  the  same  malformation.  She  had 
borne  him  three  children,  two  of  whom  were  twins, 
and  all  with  a  supernumerary  finger  and  toe,  on  each 
hand  and  on  each  foot.  Desirous  of  learning  some 
more  particulars  in  regard  to  this  peculiarity,  and 
especially  whether  it  would  continue  to  be  transmitted 
to  his  offspring,  I  recently  addressed  a  communica- 
tion on  the  subject  to  Professor  Colburn,  to  wdiich 
he  kindly  replied,  acquainting  me  with  the  following- 
additional  and  interesting  facts,  which  I  will  give  in 
his  own  language.  "I  do  not  know  at  what  period 
this  peculiarity  was  imported  into  this  country.  It 
came,  I  believe,  from  Scotland,  in  the  name  of 
Kendall.  From  the  Kendalls  it  came  into  the  family 
of  Green,  by  marriage.  My  grandfather  married  a 
Green,  and  thus  it  got  into  our  family.  How  many, 
if  any,  of  my  uncles  had  this  mark,  I  know  not. 
My  father  had  it  on  each  hand  and  foot;  of  hi^ 
children,  one  brother  and  myself  have  it  complete. 
One  other  brother  has  one  odd  fmgcr ;  he  has  two 
children,  twins,  and  both  completely  furnished  wath 
with  odd  fmgers  and  toes.  The  other  brothers  and 
sisters  have  it  not,  either  themselves,  or  in  their 
children.  My  wife  is  great-granddaughter  of  my 
13 


98  CAUSES 

grandfather;  her  mother  has  one  finger  and  one  toe 
extra.  This  fact  accounts  for  her  beinj;  born  with 
the  full  complement  of  supernumerary  fingers  and 
toes;  they  were  cut  off  at  her  birth,  by  the  attend- 
ing physician.  Since  I  saw  you  I  have  been  favored 
with  another  daughter,  with  like  accoutrements, 
and  have  not  any  doubt  but,  even  though  I  had  as 
many  children  as  Gideon  of  old,  by  my  present  wife, 
they  would  all  show  alike  in  this  respect,  and  be, 
as  my  four  daughters  now,  six  fingered,  and  six 
toed.  The  descendants  of  Kendall  generally  have 
this  distinction,  or  can  tell  of  some  kinsman  who 
has." 

In  some  of  our  little  secluded  villages  in  New 
England,  striking  resemblances  and  constitutional 
characteristics,  may,  for  reasons  which  will  now  be 
sufficiently  obvious,  not  unfrequently  be  seen  among 
their  native  inhabitants.  The  same  thing  may  also 
be  remarked  on  a  more  extended  scale  among  tribes, 
as  the  Jews  and  Gypsies,  who  by  separating  them- 
selves in  a  great  measure  from  other  people,  have 
for  ages  retained  certain  distinctive  peculiarities  of 
countenance. 

Among  the  inferior  animals — and  the  same  gen- 
eral laws  govern  their  propagation  as  our  own — it 
is  ever  found  injurious  to  the  stock  to  exclude  a 
limited  number  of  individuals  from  the  rest  of  the 
race,  and  allow  them  to  breed  in  and  in.  The 
breeders  of  animals  being  well  apprized  of  this  fact, 
are    in    the  habit  of  introducing   frequent   crosses 


OF    CONSUMPTION.  99 

among  their  stocks.  A  like  necessity  for  this  cross- 
ing exists  also  in  the  vegetable  kingdom.* 

The  law  restraining  marriages  between  near 
relatives,  is  as  old  as  Moses,  and  not  milikely  had 
its  origin  in  observation.  The  remark  that  it  is 
unlucky  to  marry  with  cousins,  has  grown  almost 
into  a  proverb,  and,  as  with  many  other  popular 
sayings,  may  be  based  in  wisdom.  In  unions  be- 
tween blood  relations,  the  various  imperfections 
existing  in  families,  as  the  morbid  predispositions, 
&.C.,  are  liable  to  be  perpetuated,  and,  in  conse- 
quence of  an  impulse  received  from  both  parents, 
are  often  aggravated  in  the  offspring.  In  support 
of  this  assertion-,  the  degeneracy  of  the  nobility  of 
Spain  and  Portugal,  and  many  of  the  royal  families 
of  Europe,  has  been  frequently  adduced. 

"Members  of  families,"  says  Dr  Clark,  in  the 
work  from  which  I  have  before  cited,  "  already  pre- 
disposed to  tuberculous  disease,  should  at  least 
endeavor  to  avoid  matrimonial  alliances  with  others 
in  the  same  condition;  but  above  all,  they  should 
avoid  the  too  common  practice  of  intermarrying 
among  their  own  immediate  relatives,  —  a  practice 
at  once  a  fertile  source  of  scrofula,  a  sure  mode  of 
deteriorating  the  intellectual  and  physical  powers, 

*  We  find  in  Mr  Combe's  work  on  the  Constitution  of  Man,  the  follow- 
ing quotation,  "  A  provision  of  a  very  simple  kind,  is,  in  some  cases,  made, 
to  prevent  the  male  and  female  blossoms  of  the  same  plant  from  breeding 
together,  this  being  found  to  hurt  the  breed  of  vegetables,  just  as  breeding 
in  and  in  does  the  breed  of  animals.  It  is  contrived,  that  the  dust  shall  be 
shed  by  the  male  blossom  before  the  female  is  ready  to  be  affected  by  it,  so 
that  the  impregnation  must  be  performed  by  the  dust  of  some  other  plant, 
and  in  this  way  the  breed  be  crossed." 


100  CAUSES 

and  eventually  the  means  of  extinguishing  a  degen- 
erated race." 

As  similar  constitutions  tend  to  perpetuate,  and 
dissimilar  to  neutralize,  the  faults  and  infirmities  of 
each  other,  the  union  of  different  temperaments, 
other  things  being  equal,  would  increase  the  proba- 
bility of  a  healthful  organization  to  the  offspring. 
To  illustrate — we  will  suppose  a  male  and  female 
to  be  united,  each  possessing  a  lymphatic  or  phleg- 
matic temperament,  the  diseases  of  which  are  apt 
to  be  scrofulous  or  tuberculous.  Now,  though  such 
morbid  predisposition  was  slight  in  the  parents,  so 
that  both  enjoyed  a  fair  share  of  health,  yet,  by 
receiving  a  double  impulse  in  the  child,  it  might 
very  likely  be  so  exaggerated  that  he  would  display 
a  marked  scrofulous  habit.  Or  imagine  a  union  of 
dark  complexions  and  the  melancholic  temperament, 
for  the  same  reasons  hypochondriasis  or  insanity — 
often  associated  with  such  temperament,  when 
strongly  marked — might  be  distinctly  developed  in 
the  offspring,  though  never  manifested  in  the  parents. 
But  on  the  other  hand,  when  temperaments  opposite 
in  their  features  come  together,  as  melancholic  and 
sanguine,  or  phlegmatic,  the  bold  and  harsh  points 
of  each  will  probably  be  softened,  and  their  morbid 
susceptibilities  consequently  become  neutralized. 
I  say  probably,  because,  as  has  already  been 
affirmed,  a  child  may  bear  semblance  in  complexion, 
form  and  constitution  to  one  parent  only.  It  may 
be  inferred,  too,  from  what  has  just  been  said,  that 
there  will  be  less  hazard  of  a  deteriorated  offspring 


OF  consu:mptiox.  101 

in  marriages  between  blood  relations,  if  there  is  a 
contrariety  in  temperament. 

Would  not  different  complexions  and  tempera- 
ments—  I  mean  of  course  in  the  same  race  —  if 
abstracted  from  all  other  sources  of  influence,  like 
opposite  electricities,  affect,  or  tend  to  each  other? 
This,  however,  is  a  mere  suggestion,  the  accuracy 
of  which  cannot  be  established  in  a  state  of  society 
where  such  a  multiplicity  of  factitious  causes,  as 
interest,  ambition,  association,  &c.,  are  continually 
swaying  the  affections  between  the  sexes. 

Other  things  equal,  a  healthful  constitution  in  the 
parents  will  be  likely  to  impart  itself  to  the  offspring ; 
and,  on  the  contrary,  if  the  parents  are  diseased,  or 
too  young,  or  too  old,  infirmities  will  be  entailed  on 
the  children,  and  commonly  in  proportion  to  their 
degree  in  the  parent  or  parents.  The  exceptions 
that  are  witnessed  will  not  affect  the  general  rule. 

That  a  great  amount  of  infirmity  and  suffering  in 
the  community  may  be  referred  to  ill-sorted  matri- 
monial connexions,  appears  to  be  a  fact  too  obvious 
for  contradiction.  The  folly,  avarice  and  vices  of 
parents,  are  often  visited,  in  the  form  of  scrofula, 
gout,  insanity,  mental  imbecility,  consumption,  &:c., 
upon  their  innocent  children  and  children's  chil- 
dren, even  to  remote  generations.  We  study,  and 
learn  how  to  improve  the  breed  of  our  horses  and 
other  domestic  animals,  while  deteriorations  in  the 
human  race  —  and  I  fear  for  reasons  too  forcible  to 
be  overcome,  —  are  allowed  to  go  on  unheeded. 
This   subject  awakened  attention,  and   laws  were 


102  CAUSES 

enactcid  in  relation  to  it,  among  the  ancient  Scots, 
but  such,  however,  to  which  we  of  the  present  day 
should  hardly  be  willing  to  submit.  Old  Burton 
quaintly  says  —  "I  think  it  has  been  ordered  by 
God's  especial  providence,  that,  in  all  ages,  there 
should  be,  once  in  six  hundred  years,  a  transmigra- 
tion of  nations  to  amend  and  purify  their  blood,  as 
we  alter  seed  upon  our  land."  And  an  analogous 
thought  is  also  expressed,  more  at  large,  by  Sir 
Humphry  Davy.  "You  saw,"  says  he,  "in  the 
decline  of  the  Roman  empire,  a  people  enfeebled  by 
luxury,  worn  out  by  excess,  overrun  by  rude  war- 
riors ;  you  saw  the  giants  of  the  North  and  East 
mixing  with  the  pigmies  of  the  South  and  West.  An 
empire  was  destroyed,  but  the  seeds  of  moral  and 
physical  improvement  in  the  new  race  were  sown ; 
the  new  population  resulting  from  the  alliances  of 
the  men  of  the  North  with  the  women  of  the  South, 
was  more  vigorous,  more  full  of  physical  power,  and 
more  capable  of  intellectual  exertion  than  their 
apparently  ill-suited  progenitors;  and,  the  moral 
effects  or  final  causes  of  the  migration  of  races,  the 
plans  of  conquest  and  ambition  which  have  led  to 
revolutions  and  changes  of  kingdoms,  designed  by 
man  for  such  different  objects,  have  been  the  same 
in  their  ultimate  results  —  that  of  improving  by 
mixture  the  different  families  of  men.  An  Alaric 
or  an  Attila,  who  marches  with  legions  of  barbarians 
for  some  gross  view  of  plunder  or  ambition,  is  an 
instrument  of  divine  power  to  effect  a  purpose  of 
which  he  is  wholly  unconscious, — he  is  carrying  a 


OF    CONSUMPTION'.  103 

Strong  race  to  improve  a  weak  one,  and  giving  en- 
ergy to  a  debilitated  population :  and  the  deserts  he 
makes  in  his  passage  will  become  in  another  age 
cultivated  fields ;  and  the  solitude  he  produces  will 
be  succeeded  by  a  powerful  and  healthy  population. 
The  results  of  these  events  in  the  moral  and  political 
world,  may  be  compared  to  those  produced  in  the 
vegetable  kingdom  by  the  storms  and  heavy  gales 
so  usual  at  the  vernal  equinox,  the  time  of  the  form- 
ation of  the  seed ;  the  pollen  or  farina  of  one  flower 
is  thrown  upon  the  pistil  of  another,  and  the  cross- 
ing of  varieties  of  plants,  so  essential  to  the  perfection 
of  the  vegetable  world,  produced."* 

To  return  to  the  consumptive  predisposition. — 
As  children,  at  the  earliest  periods  of  their  exist- 
ence, at  birth  even,  are  sometimes  affected  with 
tubercles,  and  when  no  taint  of  the  sort  can  be 
traced  in  the  family,  there  must  be  other  conditions, 
beside  those  mentioned,  existing  in  the  parent's 
constitution,  or  certain  unknown  influences  operating 
in  the  production  or  growth  of  the  embryo,  impress- 
ing upon  its  organization  tuberculous  disease,  or  a 
propension  to  it. 

Sometimes  consumption  sweeps  off"  whole  families 
of  children  and  yet  we  cannot  trace  it  to  an  hered- 
itary origin.  Laennec  has  observed  that  numerous 
families  are  at  times  destroyed  by  the  disease,  whose 
parents  were  never  affected  by  it.  He  mentions  an 
instance  in  which  the  father  and  mother  died  upwards 

'  Consolations  in  Travel. 


104  CAISKS 

oi' eighty  years  of  age,  and  of  acute  maladies,  after 
having  seen  fourteen  children,  born  healthy,  and 
without  any  indications  of  a  disposition  to  phthisis, 
successively  carried  off'  by  it,  between  the  ages  of 
fifteen  and  thirty-five.* 

Dr  Clark,  also,  informs  us  that  instances  have 
come  under  his  observation,  "where  whole  families 
have  fallen  victims  to  tuberculous  consumption, 
while  the  parents  themselves  enjoyed  good  health 
to  an  advanced  age,  and  were  unable  to  trace  the 
existence  of  the  disease  in  their  families  for  genera- 
tions back." 

It  is  highly  probable  that  a  greatly  deteriorated 
state  of  health  in  parents,  whether  from  excessive 
dissipation,  or  any  other  cause,  may  occasionally 
entail  on  the  offspring  the  tuberculous  predispo- 
sition. 

A  vitiated  state  of  health  in  the  mother  during 
pregnancy,  may  unquestionably  exercise  a  deleteri- 
ous influence  upon  the  new  being  Avhose  integrity 
and  life  are  so  intimately  connected  with  her  own ; 
and  perhaps  that  physical  condition  connected  with 
a  disposition  to  tubercles,  may^  sometimes  be  thus 
originated. 

The  health  of  the  female,  therefore,  at  such  time 
being  important  to  the  perfection  of  her  offspring, 
should  be  most  strictly  regarded,  and  more  espe- 
cially if  her  constitution  is  naturally  delicate.  The 
diet  ought  to  be  light   and  of  the  most  digestible 

*  Traite  de  1' Auscultation,  &c.    2e  edition,  tome  ler,  p  G51. 


OF    CONSUMPTION.  105 

character,  and  if  her  system  is  plethoric,  or  disposed 
to  inflammatory  affections,  she  should  principally  be 
confined  to  vegetable  food.  A  popular,  but  very 
erroneous  opinion  exists,  that  women  should  feed 
high  during  pregnancy,  and  is  no  doubt  the  occasion 
of  the  frequent  necessity  of  abstracting  blood  during 
this  state.  Those  various  stimulants,  too,  taken 
under  the  palliating  name  of  medicines,  as  cordials, 
tinctures,  &c.,  and  in  short,  all  stimulating  drinks, 
should,  as  a  general  rule,  be  scrupulously  avoided. 
The  same  may  be  said  of  all  active  medicinal  sub- 
stances—  and  more  especially  calomel  and  other 
mercurial  preparations,  —  since  they  must  act  indi- 
rectly on  the  tender  offspring,  as  yet  but  little 
capable  of  bearing  their  influence.  If  the  weather 
is  suitable,  and  no  special  circumstances  forbid,  daily 
and  moderate  exercise  should  be  taken  in  the  open 
air.  Close  and  crowded  apartments,  late  hours, 
and  all  species  of  dissipation,  ought  to  be  carefully 
shunned,  and  the  mind  kept  at  ease,  free  from  all 
undue  excitements,  and  the  influence  of  the  depress- 
ing passions.  The  bowels  should  be  regulated, 
when  needful,  by  the  mildest  means  practicable. 

By  pursuing  such  a  course,  and  thus  maintaining 
the  health  as  perfect  as  is  compatible  with  the 
existing  state  of  things  —  though  it  must,  of  course, 
vary  in  different  constitutions,  —  the  best  possible 
security  will  be  given  to  the  welfare  of  the  offspring. 

14 


106 


CHAPTER  X. 

CAUSES    OK    CONSUMPTION    CONTINUED. THOSE    WHICH     ACT    IN- 
DIRECTLY,   OR    ON    THE    GENERAL    SYSTEM. 

Every  thing  which  operates  on  the  living  body, 
and  more  especially  in  infancy  and  early  life,  either 
directly  or  indirectly  to  disturb,  depress  or  exhaust 
the  vital  powers,  is  inimical  to  the  due  and  healthful 
development  of  the  animal  constitution,  and  may 
tend  to  originate,  w^hen  the  climate  favors,  a  tuber- 
culous habit. 

Climate.  —  Under  the  general  history  of  consump- 
tion, I  have  spoken  of  the  climates  in  which  it  is 
most  prevalent,  and  have,  therefore,  but  few  addi- 
tional remarks  to  make  on  the  subject.  A  cold  and 
variable  climate,  and  particularly  if  subjected  to  the 
influence  of  high  winds,  may  be  ranked  among  the 
most  prominent  causes  in  the  production  of  consump- 
tion. It  is  during  those  seasons  of  the  year  when 
the  most  frequent  vicissitudes  are  experienced  —  as 
in  our  springs,  for  example,  —  that  the  disease  is  in 
a  special  manner  apt  to  reveal  itself. 

Tubercles  often  follow  the  sudden  migration  from 
a  warm  to  a  temperate  or  cold  country.  The 
negroes  who  are  removed  from  their  native  tropical 
abodes  to  harsher  climes,  become  the  very  frequent 
victims  of  tuberculous  diseases,  and  the  danger  is 


CAUSES    OF    CONSUMPTION'.  107 

generally  proportioned  to  the  suddenness  of  the 
change.  "The  native  African  who  removes  imme- 
diately to  Europe,  seldom  lives  over  two  winters  in 
it ;  whilst  the  negro  who  has  been  brought  to  the 
West  Indies,  and  subsequently  to  the  Southern 
States  of  North  America,  previously  to  his  arrival 
in  more  northern  countries,  and  enjoys  necessary 
food  and  clothing,  will  often  not  suffer  materially 
from  the  change."* 

It  would  appear  from  a  table  in  Dr  Clark's  treatise 
on  consumption,  showing  the  relative  mortality  of 
this  disease  among  the  blacks  and  whites  of  the 
West  Indian  army,  during  the  period  of  eight  years, 
that  ne2:roes  are  more  obnoxious  to  it  than  Euro- 
peans.  It  appears  from  this  table,  that  in  every 
thousand  deaths  among  the  whites,  a  hundred  and 
twenty,  or  a  little  more  than  one  eighth,  are  from 
pulmonic  diseases ;  whereas,  in  every  thousand 
deaths  among  the  blacks,  four  hundred  and  seventy- 
two,  or  nearly  one  half,  are  occasioned  by  pulmonic 
diseases. 

Insuffi-cient  clothing,  and  undue  exposure.  —  Females 
in  a  particular  manner  are  apt  to  expose  themselves, 
with  too  slight  clothing,  to  the  vicissitudes  of  our 
climate.  Their  common  practice,  also,  of  wearing 
thin  shoes  and  stockings  in  the  cold  seasons,  is 
certainly,  in  delicate  constitutions,  attended  with  no 
little  hazard  to  health.  The  extremities,  in  scrof- 
ulous young  girls  especially,  should  always  be 
guarded  with  the  most  watchful  care. 

*Copeland'i  Medical  Dictionary.     Article,  Climate. 


108 


CAUSES 


The  clothing  generally  of  weakly  and  tuberculous 
individuals,  the  vital  reaction  of  whose  bodies  is 
always  feeble,  should  ever  be  scrupulously  adapted 
to  the  variations  both  in  the  hygrometrical  and 
thermometrical  states  of  the  atmosphere.  Warm 
garments  should  be  put  on  whenever  the  sensations 
indicate,  whether  it  be  January  or  July. 

Delicate  children  ought  always  to  be  warmly 
clad,  and  the  dangerous  experiment  of  attempting 
to  harden  them  by  exposure,  avoided;  since  to 
endure  such  ordeal,  they  should  be  already  hardy. 
Hence  it  is  that  in  savage  life  few  weakly  children 
live  to  grow  up. 

Exposure  to  a  cold,  damp  air,  without  exercise, 
or  not  sufficient  to  ensure  reaction,  or  to  a  current  of 
cold  air  blowing  on  some  part  of  the  body,  may,  per- 
haps by  suddenly  checking  the  healthy  function  of  the 
skin,  or  in  some  other  way  not  understood,  derange 
the  pulmonary  function,  and  thus  be  instrumental  in 
developing  tuberculous  disease  in  the  predisposed. 

Diet.  —  In  a  state  of  society,  where  all  the  arts  of 
cookery  are  brought  into  requisition  to  tempt  the 
palate,  errors  in  diet  are  almost  inevitable,  and 
may  not  unfrequently  operate  as  the  occasional 
cause  of  consumption.  They  may  relate  to  the 
quantity  or  quality  of  the  food,  or  to  both. 

In  infancy  and  childhood,  a  careful  attention  to 
the  diet  is  of  the  highest  consideration,  for  faults  in 
regard  to  it,  at  this  period  especially,  must  produce 
the  most  baleful  influence;  either  creating  morbid 
predispositions  in  the  system,  or  strengthening  and 


OF    CONSUMPTION.  109 

exciting  such  as  already  exist.  The  nourishment 
should  be  in  sufficiency  to  answer  the  demands  of 
the  economy,  but  never  in  excess.  If  the  diet  is 
defective  in  early  life,  the  organs  will  not  be  duly 
developed,  and  the  body  will  be  feeble,  and  continue 
puerile  in  many  of  its  characters — a  state  before 
shown  to  be  intimately  associated  with  a  consumptive 
predisposition.  And  on  the  other  hand,  if  it  is 
superabundant  and  exciting,  a  plethoric  and  inflam- 
matory state  of  the  system  will  be  induced,  highly 
incompatible  with  the  equable  and  healthful  play  of 
the  different  functions,  and  tending  indirectly  to 
waste  the  energies  of  life.  How  often  is  it,  that 
fat,  plethoric,  meat  eating  children,  their  faces 
looking  as  though  the  blood  was  just  ready  to  ooze 
out,  are,  with  the  greatest  complacency,  exhibited 
by  their  parents  as  patterns  of  health !  But  let  it 
ever  be  remembered  that  that  condition  of  the  system 
popularly  called  rude  or  full  health,  and  the  result 
of  high  feeding,  is  too  often  closely  bordering  on  a 
state  of  disease. 

A  mixed  and  indigestible  diet  is  too  frequently 
allowed  to  young  children,  injuring  the  digestive 
powers,  vitiating  the  general  health,  and,  if  there  is 
a  tuberculous  tendency,  hastening  it  into  active 
existence.  A  due  adaptation  of  the  food,  both  in 
respect  to  quantity  and  quality,  to  the  age,  consti- 
tution and  habits  of  life,  is  always  of  the  highest 
importance  as  it  regards  the  health  of  the  indi- 
vidual. 

Nature,  the  safest  of  guides,  has  plainly  indicated 


no  CAUSES 

the  diet  she  has  designed  for  early  infancy,  and 
mothers  will  do  a  positive  wrong  to  their  offspring 
by  neglecting  her  dictates.  The  child,  during  its 
early  existence,  should  derive  its  nourishment 
exclusively  from  human  milk,  and  from  that  of  the 
mother,  unless  circumstances  forbid,  when  an  amia- 
ble, temperate,  healthy  young  nurse  should  be 
employed.  I  specify  such  qualities,  because  it  is 
well  established  that  turbulent  and  evil  passions, 
bad  diet,  stimulating  drinks,  and  depraved  health 
from  any  cause,  necessarily  vitiate  the  secretions, 
and  among  others,  that  of  the  milk,  rendering  it 
more  or  less  deleterious  to  the  tender  being  it  is 
designed  to  nourish.  Medicines  introduced  into  the 
system  of  the  nurse,  act  speedily  on  the  infant,  and 
in  truth,  few  secretions  are  more  affected  by  inci- 
dental circumstances  than  that  of  the  milk.  It 
therefore  behoves  every  nursing  mother,  who  regards 
the  well-being  of  her  offspring,  and  especially  if  her 
constitution  is  feeble  and  delicate  to  pay  particular 
attention  to  all  those  circumstances  of  diet  and 
regimen  which  tend  to  ensure  moral  and  physical 
health. 

Children  who  are  brought  up  by  hand,  as  it  is 
termed,  are  apt  to  be  infirm  and  to  die  in  early  life. 
Infants  that  are  weakly,  and  suspected  of  a  tuber- 
culous taint,  should  be  nursed  at  least  a  full  year. 
If  the  mother  is  predisposed  to  tubercles,  it  is  cer- 
tainly a  question  worthy  of  consideration,  whether 
it  would  not  be  more  prudent  to  employ  a  healthy 
nurse  for  her  offspring. 


OF    CONSUMPTION.  Ill 

A  solid  animal  diet  should,  to  say  the  least,  never 
be  allowed  to  childhood  till  the  teeth  are  sufficiently 
advanced  to  effect  its  mastication  with  facility.  The 
frequent  practice  of  the  nurse  of  artificially  breaking 
down  such  food,  or  of  actually  chewing  it  in  her 
own  mouth  for  the  infant,  is  hostile  to  nature's 
clearest  indications,  and  cannot  be  too  strongly 
reprobated.  A  diet  of  milk  and  mild  farinaceous 
articles,  with,  perhaps,  light  animal  decoctions, 
appears  best  suited  to  the  early  years  of  life.  Tea, 
coffee,  and  other  stimulating  drinks,  are  surely  not 
required,  and  their  effects  on  the  system  at  this 
tender  period  of  existence,  are  undoubtebly  per- 
nicious. 

There  exists  a  prevalent  idea  that  scrofulous  and 
tuberculous  individuals  require  a  full  and  nutritious 
diet,  and  hence  they  are  often  urged  to  a  free  use  of 
solid  animal  food.  Such  ought  certainly  to  be  well 
nourished,  but  excessive  nourishment  may  create 
the  very  evils  it  is  designed  to  remedy.  I  believe 
it  to  be  very  rare  in  any  constitution,  surely  when 
not  influenced  by  habit,  that  more  than  one  meal  of 
solid  animal  food  is  required  during  the  twenty-four 
hours.  And  whenever  there  exists  an  evident  in- 
flammatory tendency,  as  is  the  case  in  some  scrofulous 
systems,  solid  animal  food,  if  used  at  all,  should  be 
taken  with  the  greatest  precaution.  Persons  who 
labor  or  exercise  much  in  the  open  air,  will  bear  a 
more  full  and  nourishing  diet  than  those  of  sedentary 
habits;  and,  other  things  being  equal,  different 
constitutions  require  a  more  or  less  nutritious  diet. 


112 


CAUSES 


Impure  atmosphere.  —  Impure  air  is  inimical  to 
health  at  all  periods  of  life,  but  is  particularly  inju- 
rious in  childhood  and  youth,  when  the  bodily 
powers  are  unfolding  themselves.  Wholesome  air, 
in  truth,  is  equally  essential  with  wholesome  food, 
to  the  development  and  integrity  of  the  human  con- 
stitution. Hence  it  is  that  crowding  individuals 
together  in  close,  ill-ventilated  apartments,  as  is 
often  the  case  in  boarding  schools,  manufactories, 
and  workhouses,  is  extremely  prejudicial,  and  may 
operate  when  long  continued,  especially  if  combined 
with  deficient  exercise,  both  as  a  predisposing  and 
exciting  cause  of  tuberculous  disease.  This  is 
probably  among  the  most  influential  causes  of  the 
frequency  of  scrofula  in  the  children  reared  in  the 
manufactories  and  workhouses  of  Europe. 

The  apartment  of  children  should  always  be  large 
and  airy,  and  exposed  some  part  of  the  day  to  the 
sun's  rays,  to  prevent  the  damp  and  chilly  state  of 
it,  which  might  otherwise  exist.  The  practice  of 
putting  several  children  in  one  close  chamber,  and 
three  or  even  more  in  the  same  bed,  which  may  be 
sometimes  witnessed,  is  deserving  of  the  greatest 
reprehension. 

Dwelling  in  narrow^  damp  lanes  in  crowded  cities, 
and  particularly  under  ground,  deprived  of  the 
kindly  influence  of  the  sun's  rays,  favors  the  devel- 
opment of  tubercles,  in  the  predisposed,  at  any 
period  of  life;  and  in  infancy  and  childhood,  as 
before  stated,  may  actually  originate  that  condition 
of  the   system   which    tends    to    their   production. 


OF    CONSUMPTION.  113 

Hence  the  frequency  of  scrofulous  and  tuberculous 
affections  in  the  children  of  the  very  poor  in  cities, 
who,  at  the  same  time  that  they  are  badly  nourished, 
commonly  reside  in  such  unhealthy  situations,  and 
are  often  so  crowded  together,  and  dirty,  that  the 
air  in  their  miserable  hovels  becomes  highly  pol- 
luted. 

Low,  cold,  damp,  marshy  situations,  where  the 
air  is  much  confined,  are  very  unfavorable  to  the 
health  of  children,  depressing  all  their  vital  powers, 
and  in  a  special  manner  contributing  to  the  produc- 
tion of  tuberculous  disease. 

"It  is  not  generally  known,"  observes  Dr  Clark, 
*'  how  limited  may  be  the  range  of  a  damp,  unhealthy 
atmosphere :  a  low,  shaded  situation  may  be  capable 
of  inducing  tuberculous  disease  in  an  infant,  while  a 
rising  ground  a  few  hundred  yards  distant  may 
afford  a  healthy  site  for  his  residence." 

A  pure,  fresh,  mild  air,  is  always  of  the  highest 
consideration  in  those  who  already  labor  under  a 
tuberculous  taint ;  and  in  the  early  years  of  life,  its 
importance  is  inestimable.  The  more  children  of 
such  constitutions  can  be  exposed  to  the  open  air, 
the  greater  will  be  their  chance  of  escaping  the 
fatal  malady  to  which  they  are  predisposed ;  and  it 
is  probably  owing  to  their  being  more  out  of  doors, 
that  they  thrive  better  during  the  summer  season, 
in  the  country,  than  in  the  town.  Many  writers 
regard  the  air  of  towns  as  more  favorable  to  the 
consumptive  than  that  of  the  country ;  this  may  be 
15 


114  CAUSES 

true  under  some  circumstances,  but  it  is  a  subject 
still  open  to  inquiry. 

Want  of  exercise.  —  The  injurious  consequences  re- 
sulting to  health  from  indolence  and  sedentary  occu- 
pations, especially  when  aided  by  the  influence  of  a 
confined  atmosphere,  must  be  familiar  to  every  one. 
Nature  manifestly  designed  us  for  active  beings, 
and  if  we  thwart  her  wise  purposes,  our  sure  retri- 
bution will  be  infirmity  and  disease. 

It  is  exercise  that  awakens  all  the  healthful  actions 
of  our  bodies,  calls  all  the  living  energies  into  in- 
crease of  life,  and  from  our  very  physical  constitution 
we  need  it,  and  in  early  life,  crave  it  almost  as  we 
do  our  food  and  drink,  and  pine  and  sicken  when 
deprived  of  it. 

Exercise  in  childhood  is  absolutely  requisite  to 
ensure  the  full  and  equable  development  of  the 
animal  frame.  It  also  imparts  to  the  animal  tissue 
a  firmness,  density  and  redness,  the  contrary  of  that 
pale,  soft  and  delicate  condition  of  it,  so  commonly 
associated  with  a  tuberculous  habit ;  and  must, 
therefore,  tend  in  a  measure  to  diminish  the  con- 
sumptive predisposition  when  it  exists. 

That  exercise  is  most  advantageous  which  calls 
numerous  muscles  of  the  body  into  simultaneous  or 
successive  action.  When,  however,  children  are 
allowed  to  play  at  will,  they  naturally  fall  into  such 
gambols  as  are  not  only  most  agreeable  to  their 
minds,  but  healthful  to  their  bodies. 

Few  things  are  more  adverse  to  the  welfare  and 
perfect  development  of  the  physical  organization, 


OF    CONSUMPTION.  115 

than  to  confine  young  persons  to  daily  tasks,  where 
one  set  of  muscles  only  is  called  into  action ;  and  in  a 
special  manner  if  the  labor  is  severe,  long  continued, 
and  conducted  in  a  confined  atmosphere.  Thus, 
children  doomed  to  the  manufactories  of  Europe, 
often  grow  up  sickly,  scrofulous,  disproportioned, 
and  deformed. 

Excessive  labor,  at  any  age,  tends  to  exhaust  the 
powers  of  the  constitution,  and  consequently  to 
favor  disease,  and  should,  therefore,  as  well  as  all 
violent  and  straining  exercises,  especially  such  as 
embarrass  the  respiratory  function,  be  guardedly 
avoided  by  those  who  are  predisposed  to  consump- 
tion. That  exercise  will  be  most  beneficial  which 
affords  pleasure  to  the  feelings,  is  pursued  in  the 
open  air,  and  can  be  long  continued  without  fatigue. 
Riding  on  horseback  ranks  among  the  best  exercises 
for  consumptive  subjects ;  it  calls  into  action  numer- 
ous muscles  of  the  body,  is  associated  with  the  full 
benefit  of  the  fresh  air,  ensures  the  free  play  of  the 
organs  of  respiration,  and  can  be  long  persisted  in, 
by  those  accustomed  to  it,  without  weariness. 
Walking  is  a  natural  exercise,  and  yields  to  none 
in  healthfulness  when  the  strength  is  such  that  it 
can  be  sufficiently  long  continued.  But  I  have 
again  to  speak  of  these  exercises  under  the  treat- 
ment of  consumption. 

Intemperance.  —  Intemperance  of  any  sort,  but  par- 
ticularly in  the  use  of  distilled  spirits,  must  be  classed 
among  the  common  causes  of  consumption.  The  rum 
drinker  is  apt,  sooner  or  later,  to  be  affected  with  a 


116  CAUSES 

cough,  especially  troublesome  when  he  first  rises  in 
the  morning,  which,  if  the  predisposition  exists,  will, 
for  the  most  part,  ultimately  terminate  in  tubercu- 
lous disease  of  the  lungs. 

Suppression  of  habitual  discharges. — A  sudden 
check  of  perspiration,  of  long  established  cutaneous 
eruptions,  or  of  any  accustomed  discharge,  whether 
natural  or  artificial,  as  of  issues,  setons,  hemorrhoids, 
&c.,  may  call  into  action  phthisis,  or  any  other 
morbid  predisposition  which  exists  in  the  economy. 

Unnatural  excesses  of  youth.  —  There  are  some 
unnatural  practices  of  youth,  which  contribute  to 
induce  that  feeble  and  vitious  state  of  the  system, 
called  cachetic,  in  w^hich  tubercles  declare  them- 
selves with  facility,  and  when  the  disposition  to  them 
already  exists,  to  hasten  their  development. 

Abuse  of  mercury  and  other  active  medicines.  —  The 
free  employment  of  calomel  during  childhood,  or 
repeated  salivations  at  any  age,  have  been  often 
ranked  among  the  causes  of  consumption.  That 
mercury,  if  used  to  excess — like  any  thing  else  tend- 
ing to  injure  the  general  health,  —  may  act  in  the 
predisposed  as  an  exciting  cause  of  tubercles,  hardly 
admits  of  a  question.  And  furthermore,  if  such 
practice  is  persisted  in  during  early  life,  it  may 
actually  generate  that  condition  of  the  system  which 
predisposes  it  to  tuberculous  affections.  A  pale, 
sallow,  and  often  semi-transparent  complexion, 
accompanied  with  cough  and  other  indications  of  a 
cachetic  state  of  the  constitution,  will  not  unfre- 
quently  be  observed  to  follow  the  long  continued 


OF    CONSUMPTION.  117 

influence  of  mercury  on  the  system.  I  have  often 
witnessed  such  peculiar  manifestations  of  injured 
health,  in  the  children  of  those  gifted  mothers  who 
are  in  the  habit  of  rashly  administering  portions  of 
calomel  for  almost  every  trifling  ailment  which  they 
exhibit ;  thus  sapping  the  energies  of  their  consti- 
tutions, creating  often  the  very  diseases  they  think 
to  cure,  and  laying  the  foundation  for  infirmity, 
suffering  and  premature  decay. 

In  children  of  pale,  delicate  complexions,  and 
scrofulous  constitutions,  mercury  should  be  employed, 
even  by  the  physician,  with  the  utmost  caution,  and 
only  in  cases  of  urgent  necessity.  But  if  the  mother 
of  such  frail  ofl*spring  keeps  calomel  among  her 
family  medicines,  and,  looking  upon  it  as  a  sort  of 
panacea,  deals  it  out  on  her  own  mistaken  judgment 
—  we  can  only  commend  them  to  the  mercy  of 
Heaven. 

Some  experiments  in  relation  to  mercury  as  a 
cause  of  tubercles,  were  made  in  France,  by  Pro- 
fessor Cruveilhier,  on  dogs.  Crude  mercury  was 
injected  into  the  lungs  through  the  air-tubes,  and 
into  the  cellular  texture  of  other  organs,  and  tuber- 
cles—  as  they  were  thought, — with  a  globule  of 
mercury  in  their  centre,  was  the  result.  M.  Andral 
is  of  opinion  that  if  these  experiments  were  conducted 
on  a  larger  scale,  genuine  tubercles  might  be  found 
in  the  lungs  of  some  of  the  animals  subjected  to 
them;  but,  with  his  usual  good  sense,  he  remarks 
that  he  should  be  inclined  to  view  them,  in  such 
cases,    as    the   product   of    a    peculiar    disposition 


118  CAUSES 

excited  into  action  by  the  artificial  irritation  created 
by  the  mercury  in  the  air-passa<^es. 

In  the  year  1810,  a  large  quantity  of  quicksilver 
was  taken  from  the  wreck  of  a  Spanish  vessel  on 
board  the  English  ship  Triumph,  of  seventy-four 
guns,  and  the  boxes  principally  stowed  in  the  bread 
room.  Many  of  the  bladders  in  which  it  was  con- 
fined—  owing  to  the  heat  of  the  weather,  and  to 
having  been  wetted  during  their  removal,  —  soon 
rotted,  and  several  tons  of  the  mercury  were  diffused 
through  the  ship,  mixing  with  the  bread,  and  more 
or  less  with  the  other  provisions.  The  consequence 
was,  that  very  many  of  the  ofllicers  and  crew  expe- 
rienced severe  salivations,  and  other  deleterious 
effects  from  the  mercury  that  was  taken  into  their 
systems,  two  dying  from  its  influence;  and  that 
nearly  all  the  live  stock,  as  well  as  cats,  mice,  a 
dog,  and  even  a  canary  bird,  died.  But  how  did  it 
affect  the  lungs  ?  The  account  informs  us  that  the 
mercury  was  very  deleterious  to  those  having  any 
tendency  to  pulmonic  affections.  That  three  men, 
who  had  previously  manifested  no  indisposition,  died 
of  pulmonary  consumption ;  and  that  one  man,  who 
had  before  suffered  from  lung  fever,  but  was  entirely 
cured,  and  another,  who  had  had  no  pulmonic  com- 
plaint before,  were  left  behind,  at  Gibraltar,  with 
•confirmed  phthisis. 

The  too  frequent  abuse  of  any  active  medicine 
in  early  life,  may  not  unlikely  tend  to  generate, 
strengthen  or  excite  the  tuberculous  tendency. 

Hard  water.  —  Some  physicians  have  regarded  the 


OF    CONSUMPTION.  119 

use  of  water  holding  in  solution  large  quantities  of 
of  salts,  as  of  lime,  &c.,  to  be  a  cause  of  scrofula 
and  tubercles.  There  is,  to  be  sure,  no  sufficient 
evidence  of  the  truth  of  such  an  opinion,  still  a  con- 
sideration of  the  influence  exercised  on  the  human 
constitution  by  impure  water,  is  of  no  small  moment, 
and  well  merits  the  attention  of  the  medical  philos- 
opher. 

Excessive  mental  labor.  —  Mental  exertion  when 
severe  and  long  continued,  tends  to  disturb  the 
just  equilibrium  of  the  nervous  power,  to  impair  the 
bodily  vigor,  and,  especially  if  united  with  confine- 
ment in  a  close  atmosphere,  may  often  aid  in  calling 
into  action  a  consumptive  predisposition. 

Overstrained  application,  in  childhood  and  youth 
particularly,  is  fraught  with  the  greatest  danger  to 
the  welfare  of  the  physical  constitution,  and  is  at 
the  same  time  at  war  with  the  plainest  dictates  of 
nature,  which  may  be  read  in  the  instinctive  propen- 
sities of  all  young  animals.  Will  not  the  young  of 
most  kinds,  if  left  to  their  own  inclinations,  quit 
their  place  of  confinement,  and  go  forth  into  the 
pure  air  and  green  fields,  there,  by  their  innocent 
and  pleasing  gambols,  to  educate  their  various 
muscles,  and  to  invigorate  all  their  living  powers  ? 

Such,  in  truth,  is  the  propensity  to  action  in 
childhood,  that  one  of  the  most  cruel  punishments 
inflicted  upon  it,  is  restraint  from  motion.  What  a 
picture  of  gayety  and  happiness  is  exhibited  by  young 
children  just  freed  from  the  confinement  of  a  school 
room!     All  their  gambols  and  boisterous  mirth,  and 


120  CAUSES 

all  the  intensity  of  pleasure  derived  from  the  con- 
traction of  their  muscles,  but  serve  to  display 
nature's  designs  in  relation  to  them  at  this  period 
of  their  existence, 

I  mean  not  to  be  understood  that  the  higher 
powers  are  to  be  neglected,  but  only  that  they 
should  not  be  forced,  while  the  physical  education, 
upon  which  so  much  of  the  health  and  happiness  of 
future  life  depend,  is  disregarded.  The  intellectual 
powers  can  only  be  unfolded  by  degrees,  and  in 
correspondence  with  the  development  of  the  phy- 
sical organization.  The  brain  of  childhood  is  soft 
and  delicate,  and  its  capabilities  must  not  be  ex- 
pected to  equal  those  of  more  mature  life.  Whenever 
it  is  overw^orked,  and  forced  into  unnatural  precocity, 
it  must  be  at  the  expense  of  the  other  functions  of 
the  living  economy,  and  an  early  death  is  too  fre- 
quently the  mournful  catastrophe.  The  pride  of 
parents  too  often  incites  them  to  force  the  minds  of 
their  offspring,  to  the  neglect  of  their  physical  im- 
provement. If  a  child  can  but  be  made  a  prodigy 
in  intellect,  no  matter  how^  puny  and  feeble  he 
becomes !  If  he  can  but  recite  well  his  Latin  and 
Greek,  no  matter  though  he  cannot  run,  and  jump, 
and  frolic,  and  digest  his  food  like  ordinary  boys ; 
these  are  but  vulgar  endowments!  There  is  such 
a  thing,  however,  as  educating  a  child  to  death. 

As  tuberculous  children  not  unfrequently  display 
a  precocity  of  mind,  proud  hopes  of  their  intellectual 
distinction  are  awakened,  to  which  all  other  consid- 
erations yield ;  their  physical  health  is  consequently 


OF    CONSUMPTIOX.  121 

but  little  regarded,  and  the  melancholy  result  is, 
that  these  high  wrought  expectations  are  all  buried 
in  a  premature  grave.  How  many  gifted  minds  fall 
victims,  either  during  their  college  life,  or  w^hat  is 
far  more  frequent,  when  the  flattering  promises  of 
their  youth  are  becoming  realized  in  the  intellectual 
splendor  of  manhood,  to  the  unconquerable  disease 
I  am  describing!  and  which  sad  conclusion  is  too 
often  referrible  to  neglect  of  early  physical  ed- 
ucation. 

A  very  common  and  erroneous  practice  has 
existed,  of  putting  weakly  children  to  sedentary 
occupations.  They  cannot  bear  hard  labor,  and  so, 
forsooth,  are  often  shut  up  from  morning  till  night 
in  a  close  atmosphere,  poring  over  their  books,  or 
perhaps  with  their  legs  crossed  on  a  tailor's  bench. 
If  a  parent  can  afford  to  bring  up  to  learning  but  one 
boy  out  of  the  family,  the  most  delicate  is  generally 
selected.  This,  however,  is  not  as  it  should  be. 
Though  a  feeble,  scrofulous  child  may  not  be  ade- 
quate to  very  hard  labor,  yet  he  should  be  brought 
up  to  such  occupations  as  are  associated  with  bodily 
exercise,  and  much  exposure  to  the  open  air,  —  for 
example,  agriculture  or  a  seafaring  life ;  which,  by 
imparting  new  energy  to  the  system,  may  enable  it 
to  resist  the  development  of  disease. 

Females  during  the  period  of  their  education,  are, 
unquestionably,  too  often  overworked.  They  must 
learn  too  much  in  too  short  a  time ;  for,  in  addition 
to  the  numerous  studies  of  their  schools,  fashion  has 
rendered  necessary  to  them  a  multiplicity  of  accora- 
16 


122  CAUSES 

plishments.  Physical  exercise  is  thus  too  apt  to  be 
neglected,  and  the  soundness  and  vigor  of  their 
bodies,  so  essential  to  their  own  happiness,  to  that 
of  their  husbands,  and  to  the  well-being  of  their 
offspring,  sacrificed. 

School  girls  who  are  much  confined  and  take  but 
little  exercise,  often  grow  up  pale  and  sallow ;  their 
skins  rough,  their  faces  pimpled ;  also  feeble  and 
nervous,  subject  to  headach,  pain  in  the  side,  indi- 
gestion, &c.  Such  appearances  are  more  particu- 
larly apt  to  be  manifested  about  the  period  of  puberty, 
and  when  a  disposition  to  tubercles  is  suspected, 
measures  which  tend  to  prevent  their  development 
should  forthwith  be  pursued ;  as  frequent  exercise  in 
the  open  air,  by  walking,  riding  on  horseback,  &c.  — 
a  mild  and  easily  digestible  diet,  a  free  state  of  the 
bowels,  warm  clothing,  especially  of  the  feet,  and 
often  repeated  dry  friction  of  the  surface. 

It  should  ever  be  borne  in  mind,  that  physical 
education,  highly  essential  to  all,  is  of  the  first  and 
most  vital  importance  in  delicate  and  tuberculous 
children ;  since  it  is  only  in  early  life  that  we  can 
hope  to  counteract  such  morbid  tendency. 

The  depressing  passions.  —  These  are,  unquestion- 
ably, in  a  state  of  advanced  society,  a  frequent  cause 
of  phthisis  in  the  constitutionally  predisposed,  and 
may,  in  some  instances,  even  originate  it  in  untainted 
bodies.  Laennec  is  inclined  to  attribute  the  preva- 
lence of  the  disease  in  cities,  to  the  numerous  and 
close  relations  among  men,  creating  more  frequent 


OF    CONSUMPTION.  123 

occasions  for  the  activity  of  all  the  gloomy  and  bad 
passions  of  the  heart. 

Nostalgia,  or  homesickness,  is  always  associated 
with  mental  depression,  sometimes  very  intense, 
and  is  commonly  ranked  among  the  causes  of  con- 
sumption. IMorton  entitles  one  of  his  species  of 
phthisis,  a  melancholia.  But  who  is  not  familiar 
w^ith  melancholy  examples  of  consumption,  following 
close  on  disappointed  ambition,  the  loss  of  property, 
the  death  of  some  near  and  dear  relative,  some 
bosom  friend,  or  disappointed  affections  ? 

Laennec  suggests  it  as  w^orthy  of  remark,  that 
the  depressing  passions,  when  long  operative,  seem 
to  contribute  most  to  the  growth  of  cancers  and 
the  various  other  accidental  productions  which  are 
unlike  any  of  the  natural  structures  of  the  body. 
He  records  a  very  striking  example,  which  was  ten 
years  under  his  observation,  of  what  he  conceived 
to  be  the  effect  of  the  depressing  passions.  The 
following  is  a  translation  of  it.  "There  existed, 
during  the  time  mentioned,  at  Paris,  a  recent 
religious  community  of  women,  who,  on  account  of 
the  extreme  severity  of  their  regulations,  had 
obtained  only  a  conditional  toleration  from  the 
ecclesiastical  authority.  Their  diet  though  austere, 
yet  did  not  exceed  what  the  powers  of  nature  could 
endure.  But  the  rigor  of  ih^iv  religions  rules  was 
productive  of  effects  both  melancholy  and  surprising. 
Their  attention  was  not  only  habitually  fixed  on  the 
most  terrible  truths  of  religion,  but  they  were  tried 
by  all  kinds  of  opposition  to   induce   them,  as  soon 


124  CAUSES 

as  possible,  to  renounce  entirely  their  own  proper 
will.  The  effects  of  this  course  were  alike  in  all. 
At  the  end  of  one  or  two  months,  the  catamenia 
were  suppressed ;  and  in  one  or  two  months  more, 
phthisis  was  evident.  They  not  being  bound  by 
vows,  I  urged  them,  on  the  first  manifestation  of 
the  symptoms  of  the  malady,  to  quit  the  establish- 
ment ;  and  almost  all  who  followed  the  advice  were 
cured,  though  many  of  them  had  already  exhibited 
evident  signs  of  phthisis.  During  the  ten  years  that 
I  was  physician  to  this  household,  I  saw  it  renewed 
two  or  three  times  by  the  successive  loss  of  all  its 
members,  with  the  exception  of  a  very  small  num- 
ber, composed  principally  of  the  superior,  the  grate 
keeper,  and  the  sisters  who  had  the  care  of  the 
garden,  the  kitchen,  and  the  infirmary ;  and  it  is 
worthy  of  remark  that  these  persons  were  those  who 
had  the  most  frequent  distractions  from  their  reli- 
gious austerities,  and  that  they  frequently  went  out 
into  the  city  on  duties  connected  with  the  establish- 
ment."* This  is  certainly  a  curious  and  interesting 
relation ;  yet  I  conceive  that  other  causes,  as  want 
of  exercise,  austere  diet,  confined  air,  must  have 
lent  their  aid  in  the  production  of  the  disease.  The 
same  author  likewise  tells  us,  that  almost  all  the 
individuals  W'hom  he  has  seen  become  phthisical 
without  the  signs  of  the  constitutional  predisposition, 
appeared  to  owe  the  origin  of  their  malady  to  deep 
or  long  continued  sorrow. 

'  Traitc  de  rAuscultation  mediate  et  dcs   maladies   des   poiinioiis  et  du 
ccEur.     Tome  ler.  p.  647 — 8. 


OF    CONSUMPTION.  125 

Grief  depresses  all  the  functions,  causes  paleness 
and  coldness  of  the  surface,  oppression  of  the  heart 
and  lungs,  derangement  of  the  skin,  and  hence  may 
frequently  operate  as  an  exciting  cause  of  consump- 
tion, as  well  as  an  indirect  and  ofttimes  unsuspected 
one  of  many  other  maladies ;  still  the  causes  of  dis- 
eases are  so  numerous,  and  so  commonly  act  in 
combination,  that  we  should  never,  without  the 
most  careful  scrutiny  of  all  the  circumstances  of  the 
case,  rest  upon  any  individual  one,  to  the  exclusion 
of  all  others. 


CHAPTER  XI. 

CAUSES  OF  CONSUMPTION  CONTINUED. THOSE  WHICH  ACT  MORE 

DIRECTLY    ON    THE    LUNGS. 

Mechanical  and  chemical  local  causes.  —  It  is  well 
known  that  there  are  numerous  occupations  which 
must  expose  those  who  are  engaged  in  them  to  the 
inhalation  of  various  irritating  substances  into  the 
lungs.  Morgagni  alluded  to  such  a  cause  of  pul- 
monary disease,  and  since  his  time,  much  importance 
has  been  given  to  it  in  the  writings  of  many  phy- 
sicians, especially  of  Great  Britain. 

We  are  told  by  Dr  Johnstone,  of  Worcester,  that 
phthisis  is  so  common  among  persons  employed  in 
dry  grinding,  or  pointing  needles  in  needle  manu- 
factories, that  they  seldom  live  to  be  forty.     Wepfer 


126  CAUSES 

gives  an  account  —  I  quote  from  Dr  Good's  Study  of 
Medicine,  —  of  the  disease  proving  endemic  at  Wald- 
shut  on  the  Rhine,  where  there  is  a  cavern  in  which 
mill-stones  are  dug  and  wrought;  the  air  is  always 
hot,  even  in  the  winter,  and  a  very  fme  dust  floats 
in  it,  which  penetrates  leathern  bags,  and  discolors 
money  contained  in  them.  "All  the  workmen  be- 
come consumptive  if  they  remain  there  for  a  year, 
and  some  even  in  a  shorter  time ;  and  they  all  die 
unless  they  apply  early  for  assistance."  Those 
engaged  in  the  manufacture  of  gun-flints,  are  also 
observed  to  suffer  much  from  pulmonic  complaints. 
It  is  probably  the  sharp  and  angular  particles  of 
silex,  the  metals,  and  some  other  substances,  that 
are  especially  irritating  to  the  lungs.  It  is  not 
proved  that  the  coal  smoke  in  cities,  or  the  common 
dust  of  their  streets  are  at  all  noxious  to  the  organs 
of  respiration;  on  the  contrary,  the  inhalation  of  a 
smoky  atmosphere  has  even  been  imagined  beneficial 
in  many  of  their  affections.  Thus  it  has  been 
asserted  that  the  progress  of  consumption  is  less 
rapid  in  smoky  towns  than  in  the  purer  air  of  the 
country  and  of  the  mountains. 

Mr  Thackrah,  in  his  work  on  the  effects  of  trades 
on  health,  has  given  us  some  interesting  information 
in  relation  to  the  morbid  influence  exercised  by 
various  irritating  substances  inhaled  into  the  lungs. 
I  trust,  therefore,  I  shall  be  excused  for  introducing 
here  a  few  short  quotations  from  it,  bearing  on  my 
subject. 

"  In  the  flax-mills,  all  the  departments,  with  the 


OF    CONSUMPTION.  127 

exception  of  the  spinning  and  reeling,  produce 
dust."  "The  dust,  largely  inhaled  in  respiration, 
irritates  the  air  tube,  produces  at  length  organic 
disease  of  its  membrane,  or  of  the  lungs  themselves, 
and  often  excites  the  development  of  tubercles  in 
constitutions  predisposed  to  consumption," 

"The  process  of  heckling  flax  is  generally  the 
most  injurious  to  health.  A  large  proportion  of 
men  in  this  department  die  young.  Very  few  can 
bear  it  for  thirty  years,  and  not  one  instance  could 
we  find  of  any  individual  who  had  been  forty  years 
either  in  this  or  any  of  the  dusty  rooms." 

^^Draw-filing  cast  iron  is  a  very  injurious  occupa- 
tion. The  dust,  is  much  more  abundant,  and  the 
metallic  particles  much  more  minute,  than  in  the 
filing  of  wrought  iron."  "The  particles  rise  so' 
copiously  as  to  blacken  the  mouth  and  nose.  The 
men  first  feel  the  annoyance  in  the  nostrils.  The 
lining  membrane  discharges  copiously  for  some  time, 
and  then  becomes  preternaturally  dry.  The  air- 
tube  is  next  affected.  Respiration  is  difficult  on 
any  increase  of  exertion ;  and  an  habitual  cough  is 
at  length  produced ;  and  morning  vomiting,  or  an 
ejection  of  mucus  on  first  rising,  is  not  unfrequent. 
The  disorder  varies,  of  course,  with  the  constitution 
of  the  individual ;  but  the  common  termination,  when 
men  pursue  the  employment  for  years,  is  bronchial 
or  tubercular  consumption."  The  case  is  remarked 
to  be  more  certainly  fatal  where  there  exists  in  the 
constitution  a  predisposition  to  tubercles  in  the 
lungs. 


128  CAUSES 

We  are  furthermore  told,  that  though  the  minute 
particles  detached  by  the  file  are  so  decidedly  inju- 
rious to  the  lungs,  still  — "  The  dust  from  old  iron, 
which  is  thrown  off  so  copiously  as  to  deposit  a 
thick  brown  layer  on  the  dress  of  the  dealers  in  this 
article,  produces  no  inconvenience."  "It  is  then 
the  for?n  rather  than  the  material,  the  spiculai,  the 
angular,  or  pointed  figure  of  the  particles  detached, 
which  we  conceive  the  chief  cause  of  injury." 

It  is  remarked  that  the  filers  are  almost  all  un- 
healthy, and  remarkably  short  lived,  and  only  one 
instance  w^as  found  of  a  man's  following  the  employ- 
ment for  twenty  years.  "At  tw^o  of  the  principal  ma- 
chine manufactories  of  Leeds,  there  are  only  tw^o  filers 
of  the  age  of  forty-eight ;  and  in  neither  case,  I  believe, 
has  the  individual  pursued  the  labor  uninterruptedly 
from  boyhood."  Magnetic  masks  or  mouth-pieces, 
by  attracting  the  particles  of  iron,  and  consequently 
diminishing  the  quantity  entering  the  lungs,  have 
been  found  in  a  measure  to  remedy  the  evil;  still, 
however,  they  are  but  little  employed. 

The  following  citation  from  Dr  Clark's  treatise 
on  consumption,  still  further,  and  very  strongly, 
illustrates  the  evil  resulting  from  mechanical  irrita- 
tions of  the  lungs.  "  But  the  history  of  the  grinders 
of  Sheffield,  recorded  by  Dr  Knight,  affords  one  of 
the  most  striking  examples  of  the  pernicious  influ- 
ence of  the  inhalation  of  mechanical  irritants  with 
which  we  are  acquainted ;  and  the  deleterious  effect 
of  such  inhalation  is  further  illustrated  by  the  differ- 
ence between  the  health  of  the  dry  and  that  of  the 


OF   CONSUMPTION.  129 

wet  grinders.  The  grinders  '  altogether  amount  to 
about  two  thousand  five  hundred ;  of  this  number, 
one  hundred  and  fifty,  namely,  eighty  men  and 
seventy  boys,  are  fork-grinders ;  these  grind  dry, 
and  die  from  twenty-eight  to  thirty-two  years  of 
age.'  On  comparing  the  diseases  of  these  men  with 
that  of  the  other  mechanics  in  Sheflield,  he  found 
that  of  two  hundred  and  fifty  grinders,  one  hundred 
and  fifty-four  labored  under  disease  of  the  chest ; 
while  only  fifty-six  were  similarly  affected  in  the 
same  number  of  workmen  engaged  in  other  trades." 

Chemists  and  druggists  are  well  known  to  be 
exposed  to  various  effluvia  and  gases,  some  of 
which  are  more  or  less  prejudicial  to  the  lungs. 
Mr  Thackrah  says,  "persons  employed  in  labora- 
tories are  frequently  sickly  in  appearance,  and 
subject  to  serious  affections  of  the  lungs.  They  are 
often  consumptive.  Few  old  men  9,re  found  in 
laboratories." 

It  should  be  remembered,  however,  that  many  of 
these  artisans  are  exposed  to  other  deleterious 
influences  beside  those  mentioned,  as  confined  at- 
mosphere, intemperance,  constrained  postures,  &c. 
If  the  rooms  in  which  the  workmen  are  employed 
are  well  ventilated,  or  their  occupations  are  con- 
ducted in  the  open  air,  nmch  less  injury  to  health 
is  experienced,  and  they  hold  out  longer  than  under 
the  contrary  circumstances. 

If  there  exists  in  the  constitution  a  predisposition 
to    consumption,    then    the    mechanical    irritations 
described  will  be  very  likely  to  excite  it  into  action ; 
17 


130 


CAUSES 


Otherwise,  simple  bronchial  or  pulmonary  inflam- 
mation will  probably  be  the  result  of  their  agency. 
When,  too,  the  system  is  exempt  from  the  tubercu- 
lous taint,  a  speedy  restoration  to  health  is  the 
common  consequence  of  a  seasonable  removal  fiom 
the  influence  of  the  local  causes.   ' 

There  are  several  occupations  which,  though 
often  associated  with  very  disagreeable  exhalations, 
still  appear  to  claim  a  remarkable  immunity  from 
consumption.  Thus  it  has  been  remarked  to  be  a 
very  rare  disease  among  butchers  and  others  engaged 
in  slaughter-houses.  It  should  be  remembered, 
however,  that  the  habits  of  such  persons  are  gen- 
erally active,  and  that  they  are  much  exposed  to 
the  invigorating  influence  of  the  open  air.  Tallow 
chandlers,  glue  makers,  and  tanners,  are  all  obnox- 
ious to  the  inhalation  of  unpleasant  animal  odors, 
yet  are  observed  to  be  but  little  liable  to  pulmonic 
affections.  Thus  Mr  Thackrah  advises  for  those 
predisposed  to  phthisis,  a  selection  from  the  employ- 
ments of  tanners,  leather-dressers,  glue  makers, 
butchers,  tallow-chandlers,  and  brush  makers. 

Stooping. — An  acquired  habit  of  stooping,  espe- 
cially in  early  life,  by  lessening  the  capacity  of  the 
chest,  and  thus  impeding  the  free  play  of  the  lungs, 
may  sometimes  aid  in  developing  disease  in  these 
organs.  It  is  essential,  not  only  to  the  health  and 
vigor  of  respiration,  but  likewise  of  the  whole  body, 
that  the  air  should  pass  with  facility  into  the  lungs, 
pervading  all  their  minute  cells,  that  it  may  duly 


OF    CONSUMPTION.  131 

exercise  its  vital  influence  on  the  entire   mass   of 
blood  as  it  circulates  through  them. 

When  any  organ  is  so  restrained  in  its  function 
as  to  accomplish  it  with  labor  and  di^culty,  actual 
disease  in  such  organ  is  very  likely,  earlier  or  later, 
to  ensue. 

The  children  at  our  schools  should  never  be 
allowed,  while  studying  or  writing,  to  incline  their 
thorax  forward  and  lean  upon  their  desks ;  as  during 
growth  and  the  pliancy  of  youth,  the  habit  of  stoop- 
ing is  very  readily  acquired.  Feeble  and  scrofulous 
children  are  very  much  disposed  to  permit  their 
shoulders  to  settle  down  and  tend  forward,  or,  as  it  is 
usually  expressed,  to  become  round  shouldered,  thus 
still  farther  abridging  a  chest  which  is  often  already 
too  small.  In  such,  therefore,  the  habit  is  to  be  par- 
ticularly watched  and  guarded  against.  Such  tend- 
ency is  best  overcome  by  exercise  in  the  open  air, 
cold  bathing,  nutritious  diet,  and  in  short,  by  all 
those  means  which  impart  vigor  to  the  constitution. 

Let  me  urge  it,  then,  as  a  point  of  the  highest 
moment  in  physical  education,  that  children,  instead 
of  approximating  themselves  to  the  condition  of  the 
quadruped,  be  taught  to  stand  erect  in  the  dignity 
of  their  nature.  To  throw  the  shoulders  back,  and 
the  chest  forward,  thus  affording  free  play  to  those 
organs  whose  function  is  so  immediately  essential  to 
the  health  of  the  whole  economy.  The  bending  of 
the  body  should  always  take  place  at  the  loins, 
rather  than  in  the  thorax. 

Students,    clerks,    tailors,    watchmakers,    shoe- 


132  CAUSES 

makers,  females  engaged  in  sewing,  as  dress  makers, 
&€.,  and  in  short,  all  whose  occupations  induce 
them  to  lean  forward,  are  liable  to  pain  in  the  side ; 
and  when  other  deleterious  causes,  as  deficient  ex- 
ercise and  confined  atmosphere,  are  at  the  same 
time  exerting  their  influence,  are  in  great  danger 
of  falling  into  consumption;  which  danger  is  of 
course  very  much  increased  if  there  exists  a  marked 
predisposition  to  the  disease.  As  compression,  too, 
must  also  be  induced  on  the  stomach  and  other 
digestive  organs,  their  functions  are  liable  to  be 
more  or  less  impeded,  and  hence  may  be  one  cause 
of  the  frequency  of  dyspeptic  symptoms  among 
persons  of  such  employments. 

Furthermore,  if,  owing  to  abridgment  of  the 
chest,  from  the  cause  mentioned,  or  that  which  I 
am  immediately  to  consider,  the  air  does  not  com- 
pletely penetrate  and  distend  the  lungs,  portions  of 
them,  from  disuse — nature  having  rendered  the 
exercise  of  our  organs  essential  to  their  integrity, 
— will  ultimately  refuse  to  admit  it,  and  thus  the 
sphere  of  respiration  may  become  permanently  con- 
tracted. The  instruments,  too,  which  are  concerned 
in  the  mechanical  part  of  the  ftmction,  as  the  carti- 
lages and  muscles,  become  rigid  and  unyielding, 
and  lose  the  facility  and  extent  of  action  they  were 
designed  to  possess,  and  which  are  so  necessary  in 
cases  of  extraordinary  muscular  exertions,  which 
must  always  be  associated  with  a  corresponding 
increase  of  action  in  the  breathing  function.  Hence 
will  ensue  shortness  of  breath  under  anv  unusual 


OF    CONSUMPTION.  133 

exercise,  as  ascending  elevations,  and  the  danger 
of  pulmonic  disease  will  be  augmented. 

Unnatural  confinement  of  the  chest  by  dress.  —  All 
tight  dressing,  especially  in  childhood  and  youth,  is 
incompatible  both  with  the  equable  development, 
and  the  fi^ee  and  necessary  motions  of  the  body. 
The  dress  of  infants  should  always  be  perfectly 
loose,  and  undue  pressure  on  any  part  of  their  bodies 
be  carefully  guarded  against.  In  some  parts  of  the 
South  of  Europe,  there  exists  a  most  barbarous 
custom  of  binding  up  young  infants  from  the  toes  to 
the  armpits,  like  mummies,  so  that  all  freedom  of 
bodily  motion  is  restrained.  In  some  instances  I 
have  even  seen  the  arms  included,  and  bound  closely 
to  the  sides.  In  such  fashion,  probably,  were  the 
swaddling-clothes  of  the  ancients,  and  it  is  astonish- 
ing that  a  practice  which  would  seem  so  obviously 
injurious,  should  be  still  persevered  in,  and  among 
civilized  people. 

Undue  confinement  and  straitening  of  the  chest 
must  at  all  periods  of  life  be  prejudicial,  and  in  a 
particular  manner  to  such  as  are  predisposed  to  con- 
sumption. Hence  the  practice  of  tight  lacings  as  it 
is  now  technically  termed,  we  almost  always  find 
classed  among  the  causes  of  phthisis,  as  well  as  of 
numerous  other  bodily  ills. 

It  is  surely  an  erroneous  notion  that  young  and 
growing  females  need  the  support  of  stays.  At  this 
time  of  life,  the  whole  body  should  be  allowed  the 
most  perfect  freedom  of  motion,  that  those  exercises 
may  be  indulged  in  without  restraint,  which  tend  to 


134  CAUSES 

develop  and  strengthen  the  animal  frame,  and  ensure 
to  it  its  beautiful  and  healthful  proportions.  Im- 
proper restraint  in  early  life  of  any  of  the  impor- 
tant physical  actions  will  always  endanger  weakness 
and  deformity. 

In  mature  life,  if  the  practice  of  artificially  con- 
tracting the  chest  is  carried  to  an  extreme,  it  must 
necessarily  embarrass  respiration,  favor  pulmonic 
disease,  and  injure,  more  or  less,  other  important 
functions  of  the  system.  The  sphere  of  the  heart's 
action,  especially,  being  much  diminished,  palpita- 
tions and  faintings  are  not  an  uncommon  conse- 
quence. 

The  chest,  as  I  have  already  said,  may  be  very 
much  restrained,  and  yet  while  the  individual  re- 
mains at  rest,  and  the  circulation  is  tranquil,  no 
material  embarrassment  be  experienced ;  but  if 
from  physical  exertion,  moral  excitement,  a  full 
meal,  or  any  undue  stimulation,  the  heart's  action 
becomes  accelerated,  and  more  extended  respiration 
is  consequently  called  for,  syncope,  and  even  death, 
unless  relief  is  immediately  afforded,  may  be  the 
sudden  result. 

Though  the  use  of  bodices  in  the  female  dress 
does  unquestionably  in  some,  and  perhaps  in  many 
instances,  exercise  an  injurious  influence  on  the 
lungs,  and  is  especially  hazardous  in  those  disposed 
to  diseases  of  the  chest,  still  I  believe  the  dangers 
of  it  have  been  in  a  measure  caricatured.  Some  of 
those  who  have  raised  the  war-cry  against  it,  have 
certainly  attempted  to  prove  too  much — have  fixed 


OF    CONSUMPTION.  135 

their  minds  too  intently  on  this,  as  a  cause  of  pul- 
monic disease,  to  the  neglect  of  many  others  which 
were  at  the  same  time  operative,  I  fear  it  is 
becoming  too  much  the  fashion  of  the  day  to  exag- 
gerate the  evils  we  wish  to  correct.  In  our  quixotic 
efforts  to  reform  abuses,  loud  and  unmeaning  decla- 
mation is  too  frequently  substituted  for  calm  and 
sober  reasoning ;  and  injudicious  attempts  made  to 
awaken  prejudice,  and  to  frighten,  to  drive  people 
into  what  is  termed  the  right  course.  Let  the  truth 
be  stated;  the  whole  truth,  and  nothing  but  the 
truth.  Whenever  we  exceed  its  bounds,  a  reaction 
against  our  cause  is  sure  to  follow. 

In  Paris,  the  head-quarters  of  corsets  and  all  the 
machinery  for  straitening  and  deforming  the  chest, 
the  influence  of  dress  —  according  to  the  careful 
observations  of  Louis,  —  in  the  production  of  con- 
sumption, is  not  very  manifest.*  I  would  by  no 
means,  however,  defend  the  practice  of  tight  lacing, 
since  it  may  doubtless,  in  the  manner  explained, 
operate  as  adjuvant  to  other  causes  of  consumption, 
and,  in  a  special  manner,  tend  to  hasten  its  devel- 
opment in  those  already  predisposed  to  it.  But 
fashion  has  built  up  too  many  prejudices  in  favor  of 
this  part  of  female  attire,  to  allow  any  hopes  of  Its 
speedy  abandonment. 

I  feel  it  my  duty,  however,  to  urge  those  females 
who  are  feeble  and  predisposed  to  consumption,  not 
to  abridge,  by  the  smallest  fraction,  the  capacity  of 

*  Surla  FJithisic,  p.  53]. 


136  CAUSES 

the  chest;  but  on  the  contrary,  to  pursue  the 
various  exercises  and  all  other  means  which  promote 
its  free  and  perfect  expansion. 

Dr  Clark  advises,  for  improving  a  narrow  and 
contracted  chest,  the  practice  of  Dr  Autenrieth,  of 
Tubingen,  of  deep  and  frequent  inspirations.  "  I 
have  been  in  the  habit  of  recommending  the  full 
expansion  of  the  chest,  desiring  young  persons, 
while  standing,  to  throw  the  arms  and  shoulders 
back,  and  while  in  this  position,  to  inhale  slowly  as 
much  air  as  they  can,  and  repeat  this  exercise  at 
short  intervals,  several  times  in  succession :  when 
this  can  be  done  in  the  open  air,  it  is  most  desira- 
ble, a  double  advantage  being  obtained  from  the 
practice.  Some  exercise  of  this  kind  should  be 
adopted  daily  by  all  young  persons,  more  especially 
by  those  whose  chests  are  narrow  or  deformed."* 

Extraordinary  exertions  of  the  lungs,  in  public 
speaking,  playing  on  ivind-instruments,^c.  —  That  a 
sort  of  physical  education,  or  a  system  of  judicious 
exercise,  may  be  required  to  elicit  the  full  capabil- 
ities of  the  lungs,  is  rendered  highly  probable  both 
from  analogy  and  observation.  The  exercise,  how- 
ever, ought  to  be  gentle,  regular,  and  such  only  as 
nature  has  manifestly  designed  for  the  organs. 

It  is  a  popular  belief,  and  not  without  foundation, 
that  singing  is  a  healthful  exercise  of  the  pulmonary 
organs.  It  calls  the  muscles  of  respiration  into  free 
action,  and  causes  the  frequent  and  full  expansion 
of  the  lungs.     But  if  it  be  carried  to  excess,  and  the 

*  Treatise  on  Pulmonary  Consumption. 


OF    CONSUMPTION.  137 

organs  of  respiration  overstrained  and  fatigued,  it 
may  become  an  occasional  cause  of  consumption. 
Reading  aloud  from  day  to  day,  and  public  speaking, 
when  not  carried  to  fatigue,  may  tend  to  invigorate 
the  lungs;  v^^hereas,  violent  efforts  of  this  sort,  and 
more  particularly  if  periodical,  and  at  considerable 
intervals,  as  happens  in  the  case  of  our  clergy,  en- 
danger pulmonic  disease;  and  when  is  added  to 
them  the  influence  of  free  living,  and  sedentary 
habits,  the  hazard  will  be  greatly  enhanced. 

Playing  on  wind-instruments  is  always  particu- 
larly perilous  to  those  individuals  who  are  predis- 
posed to  pulmonary  hemorrhage,  or  consumption. 

Contagion. — The  propagation  of  consumption  by 
contagion  was  advocated  by  Morgagni,  and  several 
other  eminent  physicians  of  former  times.  In  the 
southern  parts  of  Europe,  the  belief  in  its  contagious 
character  still  continues  very  prevalent,  and  in  some 
places  the  furniture  of  a  room  where  an  individual 
had  died  of  consumption,  is  either  changed  or 
destroyed.  "At  Rome,"  says  Dr  Clark,  "a  gen- 
tleman of  my  acquaintance  was  refused  lodgings 
from  suspicion  that  he  was  consumptive ;  and  it  was 
only  after  a  friend's  engaging  to  pay  for  all  the  fur- 
niture of  the  lodgings,  should  he  die,  that  he  was 
admitted."  And  a  law  once  existed  there,  by  which 
the  proprietor  of  the  house  in  which  a  consumptive 
patient  died,  could  claim  payment  lor  his  furniture, 
which  was  burnt.* 

"  On  the  Climate  and  Diseases  of  the  South  of  France,  Italy,  «fec,,  p.  41. 

18 


138  CAUSES 

Lacnnec  tells  us  that  he  produced  a  tubercle  in 
his  finger  by  slightly  grazing  it  with  a  stroke  of  the 
saw,  while  examining  some  vertebrae  containing 
tubercles.  lie  rightly  observes,  however,  that  but 
little  importance  is  to  be  attached  to  a  single  instance. 
Perhaps  it  was  not  a  genuine  tubercle.  Laennec 
does  not  consider  phthisis  to  be  contagious  in  France, 
and  such  is  the  common  opinion  of  the  French 
physicians. 

"  In  England,"  says  Dr  Heberden,  a  very  accurate 
medical  observer,  "  we  have  very  little  apprehension 
of  the  contagious  nature  of  consumption;  of  which, 
in  other  countries,  they  are  fully  persuaded.  I  have 
not  seen  proof  enough  to  say  that  the  -breath  of  a 
consumptive  person  is  infectious ;  and  yet  I  have 
seen  too  much  appearance  of  it,  to  be  sure  that  it  is 
not ;  for  I  have  observed  several  die  of  consump- 
tions, in  whom  infection  seemed  to  be  the  most 
probable  origin  of  their  illness,  from  their  having 
been  the  constant  companions,  or  bedfellows,  of 
consumptive  persons."*  Dr  Cullen  asserts  that  in 
many  hundred  instances  which  he  had  seen,  there 
was  hardly  one  that  appeared  to  him  to  have  orig- 
inated from  contagion.  At  the  present  day,  but 
few,  if  any,  English  or  American  physicians  regard 
consumption  as  a  contagious  disease ;  and  the  people 
associate  freely,  eat,  and  sometimes  even  sleep  with 
those  laboring  under  it,  without  the  slightest  appre- 
hension of  danger.     It  often  happens,  it  is  true,  that 

*  Commentaries. 


OF    CONSUMPTION.  139 

several,  and  occasionally  all  the  members  of  a  family, 
will  in  quick  succession  become  the  victims  of  con- 
sumption ;  but  as  there  is  usually,  in  such  instances, 
either  an  hereditary  predisposition,  or  a  tendency 
from  some  other  cause  to  the  malady,  we  may,  for 
the  most  part,  rationally  attribute  its  successive  and 
rapid  development  to  occasional  influences,  oper- 
ating upon  such  unfortunate  families,  when  the 
disease  is  once  introduced  among  them.  These  are 
undue  confinement,  fatigue,  loss  of  sleep  and  mental 
anxiety,  in  attendance  on  the  sick ;  and  often  grief, 
too  deep  to  be  comforted,  for  the  loss  of  near  and 
dear  kindred.  Such  causes  must  derange  the  health, 
weigh  down  and  exhaust  the  energies  of  life,  and 
thus  favor  the  activity  of  any  morbid  susceptibility 
which  may  exist  in  the  constitution. 

The  conclusion,  then,  to  which  I  think  we  must 
arrive  on  the  subject,  is,  that   though  phthisis  is 
probably  not  contagious,  still  we  cannot  regard  the 
question  as  determined;   and,  in  truth,  so  multiplied 
and  complicated,  often,  are  the  causes  which  may 
lend  their  aid  in  the  production  of  pulmonary  tuber- 
cles, that  it  is  oftentimes  extremely  difficult  to  satisfy 
ourselves  of  the  degree,  or  even  certainty,  of  the 
agency  of  any  one  taken  individually.     As,  how^ever, 
it  is  not   impossible  that  this,  like  some  other  dis- 
eases,   may  be    contagious    in  a  low  degree,  and 
under    favoring    circumstances,    I    would,    by    all 
means,  urge  caution  against  unnecessary  exposure 
to  relatives  and  friends  laboring  under  consumption, 
as  inhaling  their  breath,  remaining  long  with  them 


140  CAUSES 

in  small  and  close  apartments,  and  particularly 
sleeping  in  the  same  bed  with  them.  Such  caution 
is  more  especially  necessary  for  those  who  are 
already  predisposed  to  tubercles. 


CHAPTER  XII. 

CAUSES  OF  CONSUMPTION  CONCLUDED. THE  INFLUENCE  EXER- 
CISED BY  OTHER  DISEASES  IN  THE  PRODUCTION  OF  TUBER- 
CLES IN  THE  LUNGS. 

Hemoptysis,  or  hemorrhage  from  the  lungs.  —  It 
is  a  common  belief  that  pulmonary  hemorrhage 
occurring,  consumption  is  very  likely  to  follow  as 
its  consequence.  In  other  words,  that  they  stand 
in  relation  to  each  other  as  cause  and  effect.  There 
is  not,  however,  adequate  evidence  that  tubercles 
can  be  produced  by  a  simple  bleeding  from  the 
lungs.  Though  a  few  modern  pathologists  have,  to 
be  sure,  thought  that  they  may  be  excited  by  the 
irritation  of  coagulated  blood  in  these  organs,  yet  by 
far  the  most  common  opinion  among  eminent  medical 
men,  both  English  and  French,  is  that  hemoptysis 
is  a  symptom  rather  than  a  cause  of  consumption. 
That  tubercles,  in  their  early  stage,  excite  an  irri- 
tation in  the  lungs,  the  consequence  of  which  is  the 
hemorrhage.  Thus  hemoptysis  following  mechan- 
ical injury,  great  physical  exertion,  a  violent  fit  of 
passion,    long   and  loud   speaking,  or  any  undue 


OF    CONSUMPTION.  141 

excitement,  or  a  suppression  of  habitual  discharges, 
in  a  healthy  constitution,  is  by  no  means  necessarily 
succeeded  by  phthisis.  But  when  it  arises  without 
obvious  cause,  more  especially  in  a  scrofulous  con- 
stitution, then  symptoms  of  consumption,  for  the 
most  part,  soon  reveal  themselves ;  for  the  tubercles 
are  already  in  existence,  of  which  the  hemorrhage 
is  but  an  indication. 

Pneumonia^  or  common  inflammation  of  the  lungs, 
usually  called  lung  fever.  —  It  is  not  proved  that 
common  inflammation  of  the  lungs  happening  in  an 
untainted  constitution,  is  capable  of  originating 
tubercles.  Both  the  observations  and  reasoning  of 
Laennec  induced  him  to  conclude  that  tubercles  are 
not  the  result  of  common  inflammation  of  any  of  the 
constituent  textures  of  the  lungs,  but  that  their 
development  is  owing  to  a  general  condition  of  the 
system.  The  careful  investigations  of  Louis  have 
led  him  also  to  a  like  conclusion;  and  which  he 
conceives  to  be  warranted  by  the  w^hole  history  of 
pneumonia.  Thus  the  inflammation  in  this  disease 
is  for  the  most  part  first  developed  at  the  base  of 
the  lungs,  and  from  thence  extends  to  their  summit ; 
whereas  tubercles  develop  themselves  almost  uni- 
formly in  an  inverse  manner.  Pneumonia  rarely 
occupies  the  two  sides  of  the  chest ;  phthisis  almost 
always  affects  both  lungs.  Phthisis  is  less  frequent 
among  males  than  females;  whereas  the  contrary 
is  true  with  regard  to  lung  fever. 

The  same  remarks  are  also  applied  to  pleurisy ; 
and  in  chronic  pleurisy,  where  tuberculous  granula- 


142  CAUSES 

tions  have  been  developed,  M.  Louis  has  often 
found  tubercles  in  the  side  not  pleuritic,  in  like 
manner  as  in  the  side  affected  with  the  pleuritic 
inflammation.  Though,  therefore,  he  does  not 
regard  it  impossible  that  lung  fever  may  exert  an 
influence  in  the  development  of  tubercles — it  being 
difficult  to  limit  possibility,  —  still  he  thinks  such 
influence  to  be  yet  very  conjectural.* 

Dr  Forbes  informs  us  "that  of  eighty  phthisical 
subjects,  into  whose  previous  history  he  had  partic- 
ularly inquired,  only  seven  had  ever  been  affected 
with  peripneumony,  and  four  of  these  had  been  per- 
fectly free  from  any  pectoral  affection  for  several 
years  before  the  invasion  of  the  phthisis."! 

But  though  common  inflammation  is  probably 
incapable  of  generating  tubercles  in  sound  constitu- 
tions, still  it  may  produce  them  where  there  is 
already  a  predisposition  to  their  formation,  or  arouse 
them  into  action  when  they  exist  in  a  dormant 
state.  When,  too,  tuberculous  disease  has  declared 
itself,  the  supervention  of  common  inflammation  may 
greatly  hasten  its  progress. 

Pubaonary  catarrh,  or  cold  on  the  lungs.  —  Man- 
kind are  much  inclined  to  attribute  the  origin  of  most 
of  their  maladies  to  taking  cold;  and  consumption, 
especially,  is  almost  always  referred  to  some  partic- 
ular period  of  exposure,  to  wetting  the  feet,  sleeping 
in  damp  sheets,  or  a  neglected  cold.     Dr  Cullen 

"  Sur  la  Phtliisie,  p.  525. 
t  Note  to  his  translation  of  L.ieniitc  on  llie  Chest. 


OF    CONSUMPTION.  143 

inclined  to  the  opinion  that  consumption  was  liable 
to  follow  catarrh  only  in  constitutions  already  pre- 
disposed to  it.  He  says,  "the  beginning  of  phthisis 
so  often  resembles  a  catarrh,  that  the  former  may 
have  been  mistaken  for  the  latter.  Besides,  to 
increase  the  fallacy,  it  often  happens  that  the 
application  of  cold,  which  is  the  most  frequent  cause 
of  catarrh,  is  also  frequently  the  exciting  cause  of 
the  cough  which  proves  the  beginning  of  phthisis."* 

These  views  of  Dr  Cullen,  though  at  variance 
with  common  opinion,  are  in  strict  accordance  with 
those  of"  our  best  modern  medical  writers.  Thus 
Louis  considers  that  the  influence  of  pulmonary 
catarrh  in  thje  production  of  phthisis,  is  no  better 
demonstrated  than  that  of  lung  fever ;  and  as  in  this 
latter  disease,  he  affirms  that  females  who,  accord- 
ing to  his  observations,  are  more  exposed  to  phthisis 
than  males,  are  less  subject  to  pulmonary  catarrh. 
Thus  of  a  hundred  and  forty-nine  cases  of  the  dis- 
ease collected  during  three  years,  only  about  one 
third  were  among  females;  and,  alluding  to  lung 
fever  and  pulmonary  catarrh,  he  says — "/e  sexe  qui 
semble  le  plus  expose  a  la  phthisie,  est  le  moins  sujet  a 
Vune  ou  a  V autre  de  ces  phlegmasies,  et  cela  dans  la 
proportion  d'un  a  trois.''^ 

Andral,  also,  states  that  for  inflammation  of  the 
lining  or  mucous  membrane  of  the  air-passages  to 
be  followed  by  the  production  of  pulmonary  tuber- 
cles, it  is  necessary  to  admit  a  predisposition. | 

»  Practice  of  Physic— 871.  t  Sur  la  Phthisie,  p.  526—7. 

t  Clinique  Medicale,  tome  4e,  p.  30,  3e  edition. 


144  CAUSES 

Epidemic  influenza  may  often  hurry  on  chronic 
cases  of  consumption,  or  render  them  acute,  and 
may  also  excite  into  action  the  tuberculous  predis- 
position. Hence  those  who  have  long  labored  under 
coughs  and  other  pectoral  symptoms,  frequently  die 
during  this  epidemic.  vStill  it  does  not  appear  that 
it  has  the  power  to  generate  tubercles  in  healthful 
constitutions. 

The  most  rational  conclusion  from  all  the  know- 
ledge w^e  have  on  this  subject,  appears  to  be,  that 
in  those  individuals  predisposed  to  consumption, 
there  often  exists  a  great  irritability  of  the  lining 
membrane  of  the  air-passages,  rendering  them  very 
subject,  on  any  undue  exposure,  to  a  cold  on  the 
lungs,  and  which  may  excite  tuberculous  disease  in 
them,  or  hasten  it  when  already  existing.  But  the 
evidence  is  far  from  being  satisfactory,  that  it  can 
generate  pulmonary  tubercles  in  sound  constitu- 
tions. 

It  should  ever  be  kept  in  mind,  too,  that  a  pul- 
monary catarrh  is  frequently  one  of  the  first  symp- 
toms of  consumption,  and  is  a  result  of  the  irritation 
of  tubercles  in  their  early  stage,  and  hence  is  very 
likely  to  be  mistaken  for  a  cause. 

Dyspepsia,  or  chronic  indigestion.  —  Indigestion, 
when  long  existing,  may  doubtless  act  as  an  excit- 
ing cause  of  consumption  in  those  already  inclined 
to  it ;  but  more  proof  than  we  now  have  is  needed 
to  show  that  it  is  capable  of  originating  tubercles  in 
constitutions  not  predisposed  to  their  formation. 
The  little  cough,  and  frequent  hawking,  at  times 


OF    CONSUMPTION.  145 

associated  with  dyspepsia,  may  be  owing,  in  part, 
at  least,  to  an  irritation  transmitted  along  the 
mucous  or  lining  membrane  of  the  digestive  organs 
to  that  of  the  air-passages,  which  is  continuous,  and 
affords  an  example  of  what  in  medicine  is  termed 
continuous  sympathy.  Sometimes  even  distinctly 
marked  symptoms  of  pulmonary  catarrh  may  be 
produced  and  maintained  by  a  morbid  condition  of 
the  organs  of  digestion.  I  may  adduce  the  example 
of  the  immoderate  spirit  drinker.  His  fits  of  cough- 
ing are  frequently  very  severe,  especially  in  the 
morning,  and  are  often  terminated  by  vomiting. 
This  cough,  if  he  persists  in  his  habits,  may  con- 
tinue for  years;  be  regarded  as  consumptive,  and 
death  finally  take  place,  and  yet  no  tubercles  be 
found  in  the  lungs.  If,  however,  there  exists  a 
tuberculous  predisposition,  then  genuine  consump- 
tion will  in  all  probability  be  the  final  result. 

Dr  Philip,  in  his  treatise  on  indigestion,  has 
delineated  a  new  variety  of  consumption  termed 
dyspeptic ;  and  has  thus  given  great  importance  to 
indigestion  as  a  cause  of  consumption,  and  doubtless 
led  many  whose  experience  and  power  of  discrim- 
ination are  inferior  to  his  own,  into  the  error  of 
confounding  the  catarrhal  cough,  described  as  some- 
times associated  with  dyspepsia,  with  true  phthisis. 
When  pulmonary  tubercles  are  actually  excited  by 
indigestion,  the  case  becomes  one  of  ordinary  con- 
sumption, differing  only  in  the  character  of  its  cause ; 
and  there  surely  can  be  no  philosophical  reason  for 
elevating  it  into  a  distinct  variety ;  otherwise,  the 
19 


146  CAUSES 

varieties  of  consumption  might  be  made  as  numerous 
as  its  imagined  causes. 

It  is  certainly  a  question  well  worth  considering, 
whether  dyspepsia  is  so  frequent  a  cause  of  phthisis 
as  we  have  been  taught  to  believe  by  many  modern 
pathologists.  Some  dyspeptics  live  to  a  good  old 
age,  and  are  remarkably  exempt  from  pulmonic 
complaints. 

In  scrofulous  and  tuberculous  constitutions,  indi- 
gestion is  often,  though  by  no  means  always, 
witnessed ;  but  here  there  is  apt  to  be  a  general 
feebleness  of  all  the  physical  functions,  in  which 
that  of  digestion  is  likely  to  partake.  In  such, 
then,  the  dyspepsia  is  not  to  be  regarded  as  a  cause, 
but  as  an  effect  of  the  same  condition  of  the  system 
which  tends  to  the  production  of  the  pulmonary 
tubercles.  To  be  sure,  if  the  derangement  of  the 
digestive  function  is  maintained  and  aggravated  by 
improper  diet,  the  development  of  consumption  may 
thus  be  hastened,  as  by  any  other  cause  which 
disturbs  the  general  health. 

It  should  furthermore  be  considered,  that  indiges- 
tion occurring  often  as  a  symptom  of  the  early  and 
obscure  beginning  of  consumption,  is  very  likely  to 
be  regarded  in  itself  as  a  primary  affection,  and  the 
phenomena  of  the  real  malady,  which  afterward 
become  plainly  disclosed,  to  be  looked  upon  as  its 
consequence.  This  confusion  of  cause  and  effect — 
jpost  hoc  ergo  propter  hoc,  —  is  unfortunately  of  every 
day  occurrence,  both  in  the  science  and  practice  of 


OF    CONSUMPTION.  147 

medicine,  and  operates  as  no  trifling  obstacle  to  its 
philosophical  advancement. 

It  is  not  my  purpose  to  undervalue  the  importance 
of  the  integrity  of  the  digestive  function  to  the  health 
of  the  lungs,  and  to  that  of  all  the  other  organs  of 
the  animal  economy,  still  I  cannot  avoid  the  con- 
viction that  the  too  exclusive  attention  given  to  it 
by  some,  has  not  unfrequently  led  to  a  neglect  of 
other  important  causes,  as  well  as  phenomena  of 
disease.  Though  the  stomach  has  doubtless  enough 
of  evil  to  answer  for,  yet  I  cannot  believe  it  to  be 
such  a  Pandora's  box  as  Mr  Abernethy  and  some 
other  modern  pathologists  would  induce  us  to  think. 
Fashion,  however,  is  not  without  its  sway  even  in 
the  healing  art,  and  we  are  all  too  prone — discard- 
ing our  own  proper  reflection  and  observation,  —  to 
fall  into  the  opinions  to  which  its  magic  influence  has 
given  currency.  It  is  far  easier  to  sail  along  with 
the  tide  of  popular  belief  than  to  strive  against  its 
force. 

Continued,  remittent,  and  intermittent  fevers.  —  All 
forms  of  fever  have  been  looked  upon  by  different 
medical  writers  as  causes  of  consumption,  and  most 
physicians  must  have  witnessed  instances  of  its 
development  during  convalescence  from  fever,  and 
often  of  an  acute  character.  In  some  cases  of  this 
kind,  tubercles  may  already  have  existed,  and  their 
progress  only  been  hastened  by  the  supervention  of 
the  fever;  whereas  in  others,  the  fever  operated, 
perhaps,  as  merely  an  occasional  cause,  calling  into 
action  a  tuberculous  predisposition.     Whether  con- 


148  CAUSES 

sumption  is  ever  thus  orii^inated  where  no  tendency 
to  it  exists,  is  questionable,  still  the  long  continued 
influence  of  obstinate  fevers,  especially  of  old  agues, 
on  the  system,  may,  by  enfeebling  and  deranging 
its  powers,  bring  it  into  that  condition  in  which 
tuberculous  disease  readily  arises. 

Several  eruptive  fevers  may  be  ranked  among  the 
occasional  causes  of  consumption. 

Smallpox.  —  This  disease  is  often  attended  with 
a  good  deal  of  irritation  about  the  air-passages  and 
lungs,  and  therefore  is  particularly  dangerous  in  the 
scrofulous  and  phthisical. 

Scarlet  fever.  —  Phthisis  is  sometimes  excited  by 
scarlet  fever ;  becoming  developed  especially  during 
convalescence  from  it,  and  often  running  its  course 
with  great  speed. 

Measles.  —  This  disease  being  ordinarily  accom- 
panied by  more  or  less  pulmonic  affection,  is  a  more 
frequent  occasional  cause  of  consumption  than  either 
of  the  two  preceding.  Hence,  occurring  in  phthis- 
ical constitutions,  and  after  the  age  of  puberty,  the 
state  of  the  lungs  should  be  watched  with  the 
greatest  solicitude,  and  in  a  particular  manner 
during  the  period  of  convalescence  from  the  erup- 
tion, since  then  is  the  time  of  greatest  danger  to 
the  lungs. 

I  have  treated  in  connexion,  as  will  have  been 
seen,  the  causes  of  phthisis,  and  its  means  of  pre- 
vention. Such  association  was  deemed  necessary 
to  save  the  repetition  which  would  otherwise  have 
been  unavoidable.     In  many  instances,  in  truth,  we 


OF    CONSUMPTION.  149 

need  but  to  know  the  cause  of  a  disease  to  be 
enabled  to  shun  it ;  in  other  words,  to  teach  its 
cause  is  to  teach  its  prevention.  I  have  only  to 
add,  therefore,  that  to  prevent  the  development  of 
consumption  in  the  predisposed,  all  those  measures 
are  to  be  employed  whose  tendency  is  to  maintain 
a  healthy  equilibrium  of  all  the  functions,  and  so  to 
ensure  such  a  state  of  vigor  of  the  system  as  shall 
be  incompatible  with  the  development  of  the  morbid 
predisposition.  These  means  I  have  briefly  stated; 
and  in  addition  I  may  here  mention  sea  bathing  as 
a  valuable  tonic,  during  summer,  for  weakly  and 
scrofulous  children.  It  is  not  safe,  however,  unless 
reaction,  indicated  by  a  glow  of  heat  on  the  surface, 
speedily  follows.  This  reaction  will  be  more  cer- 
tainly insured  if  the  digestive  organs  are  first  regu- 
lated, and  brisk  friction  of  the  surface  is  practised 
immediately  before  and  after  the  bathing.  Rapid 
sponging  of  the  body  with  cold  salt  water  may  in 
like  manner  be  often  employed  with  advantage.  In 
very  delicate  children,  with  feeble  powers  of  reac- 
tion, tepid  bathing,  especially  with  salt  water,  may 
be  useful. 


150 


CHAPTER  XIII. 

TREATMKNT    OF    CONSUMPTICflN. 

It  is  very  questionable  —  humiliating  as  must  be 
the  acknowledgment  to  the  pride  of  science, — 
whether  we  have  hitherto  made  any  advances  in 
our  strictly  medical  treatment  of  consumption.  And 
yet  the  numerous  pretended  specifics  that  have 
been  continually  announced,  and  the  confidence 
with  which  even  physicians  of  eminence  often  speak 
of  their  own  remedies,  might  lead  one  to  imagine 
that  phthisis  was  as  much  under  our  control  as  some 
of  our  most  manageable  diseases.  I  believe  it  will 
be  found  a  general  truth,  that  the  more  fatal  is  a 
malady,  the  more  numerous  will  be  the  remedies 
that  certainly  cure  it.  There  are  some  diseases, 
already  alluded  to,  much  resembling  phthisis,  and 
which,  being  comparatively  innocuous,  have  recov- 
ered during  the  use  of  very  simple  and  often  opposite 
remedies;  and  hence  it  is  that  such  have  often 
acquired  a  false  repute  in  the  cure  of  consumption. 
It  is  in  fact  only  of  late  years  that  we  have  under- 
stood the  true  character  of  the  disease,  and  been 
enabled  to  distinguish  it  from  several  other  affections 
of  the  lungs  bearing  a  likeness  to  it. 

We  can  then,  in  our  present  state  of  knowledge, 
only  hope  to  retard  the  course  of  consumption, 
indirectly  and  negatively,  by  acting  on  the  consti- 


TREATMENT    OF    CONSUMPTION.  151 

tution  through  the  instrumentality  of  diet  and 
regimen,  and  by  relieving  incidental  affections  with 
which  it  may  be  complicated.  Medical  science  has 
yet  discovered  no  remedy  which  exercises  a  direct 
and  specific  healing  influence  on  the  tubercles 
themselves. 

The  details  of  the  medical  treatment  not  coming 
within  the  design  of  the  present  work,  I  shall  con- 
fine myself  to  a  consideration  of  such  means — 
and  they  are  by  far  the  most  important,  —  as  all  may 
comprehend  and  safely  employ. 

Irritation  on  the  surface  of  the  body.  —  It  seems  to 
be  a  fact  highly  probable  in  physiology,  that  the 
function  of  the. skin  is  in  some  measure  auxiliary  to 
that  of  the  lungs ;  thus  a  healthy  and  active  state  of 
it,  is  ever  favorable  to  facility  and  freedom  of  respi- 
ration, and  is  especially  important  to  those  whose 
lungs  are  diseased,  or  predisposed  to  disease.  Pul- 
monic diseases  are  but  little  prevalent  in  equatorial 
regions,  where  the  heat  maintains  a  constant  deter- 
mination of  blood  to  the  surface,  and  a  high  activity 
of  the  cutaneous  function. 

Excitation  of  the  skin,  then,  is  certainly  a  remedy 
of  no  trifling  value  to  the  consumptive.  To  effect 
it,  various  methods  are  employed.  Dry  friction  by 
means  of  a  brush  or  coarse  cloth,  extended  over  the 
whole  body,  being  more  particularly  active  on  the 
chest,  may  be  advantageously  practised  twice  or 
thrice  a  day,  and  continued  till  a  considerable  glow 
of  heat  is  excited.  The  thorax  may  also  be  repeat- 
edly sponged  with  warm  salt  water,  then  wiped  dry 


152  TREATMENT 

with  a  coarse  towel,  and  the  dry  friction  protracted 
till  reaction  is  produced.  When  the  skin  is  cold 
and  quite  inactive,  stimulating  substances  may  be 
applied  to  it,  as  strong  vinegar,  alcohol,  camphorated 
spirit,  water  of  ammonia,  and  other  alkaline  solu- 
tions. Such  are  termed  rubefacients,  and  often 
exercise  a  marked  palliative  influence  on  some  of 
the  symptoms  of  consumption,  as  the  cough,  dys- 
pnoea, and  local  pains.  They  ought  to  be  warmed 
and  applied  with  brisk  friction,  which  is  especially 
necessary  with  respect  to  some  of  them,  to  prevent 
the  unpleasant  sensation  of  coldness  which  would 
otherwise  follow  their  rapid  evaporation. 

That  uncomfortable  sense  of  burning  often  expe- 
rienced in  the  hands  and  feet,  in  the  fore  part  of 
the  night,  will  be  greatly  alleviated  by  bathing  them 
with  cool  alcohol. 

Flannel  next  to  the  skin  may  be  of  service  to  the 
consumptive,  by  the  irritation  it  produces,  as  well 
as  the  defence  it  affords  against  cold.  A  large 
plaster  of  Burgundy  pitch,  or  something  of  a  similar 
nature,  worn  on  the  chest,  will  also  serve  the  double 
purpose  of  maintaining  an  external  local  irritation, 
and  of  shielding  it  in  a  measure  against  the  atmos- 
pheric vicissitudes. 

Issues,  setons,  blisters,  &c.,  may  be  suited  to 
some  cases  and  stages  of  consumption,  but  as  they 
ought  only  to  be  employed  by  the  counsel  of  the 
physician,  a  consideration  of  them  will  of  course  be 
omit.ted. 

Diet.  —  In  establishing  a  plan  of  diet  for  the  con- 


OF    CONSUMPTION. 


153 


sumptive,  the  constitution,  previous  habits  of  life, 
particular  symptoms  in  individual  cases,  should  all 
be  kept  strictly  in  view.  Only  general  rules,  there- 
fore, subject  to  modification  from  circumstances,  can 
be  laid  down  in  regard  to  it.  Where  a  strong 
inflammatory  disposition  exists,  only  the  mildest 
vegetable  diet  is  admissible ;  and  on  the  other  hand, 
where  this  tendency  is  but  small,  a  somewhat  more 
nutritious  and  stimulating  food  may  be  allowed.  I 
have  witnessed  a  few  instances  where  solid  animal 
food  and  wine  were  taken  through  the  whole  disease, 
and  without  obvious  injury.  Such,  however,  are  to 
be  viewed  merely  as  exceptions  to  a  general  rule, 
and  exceptions,  I  am  convinced,  of  a  much  more 
rare  crccurrence  than  is  commonly  imagined. 

The  rapid  wasting  of  the  flesh,  and  exhaustion  of 
the  powers  of  life,  I  acknowledge,  often  appear  to 
indicate  stimulants  and  a  more  nutritious  diet ;  but 
the  indication  is,  for  the  most  part,  deceptive;  and, 
if  yielding  to  it,  meat,  wine,  tonics  and  condiments 
are  indulged  in,  the  cough  and  embarrassment  of 
respiration,  as  well  as  the  other  morbid  phenomena, 
will  commonly  be  aggravated,  pulmonic  inflamma- 
tion perhaps  be  excited,  and  the  result  very  likely 
be  an  increase,  instead  of  a  diminution  of  the 
general  emaciation  and  exhaustion.  The  truth  is, 
the  loss  of  flesh  is  not  ordinarily  referrible  to  defec- 
tive diet,  but  to  the  influence  exerted  over  nutrition 
by  the  disease  which  is  going  on  in  the  lungs ;  and 
in  proportion  as  the  action  of  this  is  lessened — 
20 


154  TRKATMEN'r 

which  is  best  effected  by  a  mild  diet  —  will  be   the 
improvement  in  the  nutritive  function. 

In  the  advance  of  consumption,  when  the  expec- 
toration and  night  sweats  are  very  copious,  pulse 
feeble,  strength  sinking,  and  flesh,  as  it  were,  melt- 
ing away,  and  the  inflammatory  tendency  small, 
cordials  and  somewhat  more  stimulating  and  con- 
centrated diet  may  be  demanded  to  support  a  little 
longer  the  expiring  flame  of  life ;  but  the  effects  of 
such  a  course,  even  in  these  extreme  cases,  should 
be  critically  watched,  lest  injury  result  from  it. 

A  mild,  farinaceous  and  milk  diet,  I  consider  to  be 
generally  best  adapted  to  consumptive  subjects,  and 
its  quantity  must  be  varied  according  to  circum- 
stances. For  example,  other  things  being  ^qual, 
one  who  was  mostly  confined  to  the  house,  would 
require,  and  be  capable  of  digesting  less  food  than 
another  who  passed  much  of  his  time  in  exercise  in 
the  open  air.  It  should  ever  be  remembered  that 
the  healthful  nourishment  obtained  from  food,  is  not 
in  proportion  to  the  quantity  taken  into  the  stomach, 
but  to  that  which  is  digested  perfectly  and  with 
facility. 

I  trust  I  need  hardly  caution  those  laboring  under 
consumption,  against  the  use  of  those  various  indi- 
gestible articles  of  food,  as  pastry,  new  bread,  &c., 
which  by  deranging  the  digestive  function,  will 
sympathetically  aggravate  all  the  other  symptoms. 

Some  consumptive  persons  have  a  very  great 
appetite,  so  that  it  is  almost  impossible  to  restrain 
them  within  the  bounds  of  moderation  in  their  diet, 


OF    CONSUMPTION.  155 

and  are  often  in  the  habit  of"  vomiting  their  food 
when  taken  in  excess ;  nature  thus  relieving  the 
stomach  of  a  task  too  great  for  its  powers  of  per- 
formance. 

In  those  cases  where  nausea  and  vomiting  are 
very  troublesome,  it  will  be  requisite  to  give  nour- 
ishment in  a  more  concentrated  form,  and  in  small 
quantities  frequently  repeated.  Solid  food  is  here 
better  retained  in  the  stomach  than  liquids. 

Few  articles  have  enjoyed  a  higher  and  more 
permanent  reputation  as  a  diet  in  consumption  than 
milk.  It  appears  to  hold  a  rank  intermediate  be- 
tween vegetable  and  solid  animal  food.  It  is  quite 
nutritious,  in  most  constitutions  readily  assimilated, 
and  occasions  less  vascular  excitement  than  flesh, 
and  hence  seems  peculiarly  adapted  to  most  cases 
of  consumption.  If,  therefore,  milk  is  agreeable  to 
the  palate  and  stomach,  it  may  be  viewed  as  a 
fortunate  circumstance,  since  little  difficulty  need 
then  be  apprehended  in  regulating  the  diet.  To 
some  persons,  however,  from  peculiarity  of  consti- 
tution, it  is  both  unpalatable  and  indigestible,  and 
of  course  cannot  be  employed. 

In  some  constitutions,  milk  taken  in  its  raw  state 
is  apt  to  run  into  the  acid  fermentation ;  this,  how- 
ever, may  often  be  prevented  by  boiling  it,  and  very 
certainly  by  adding  to  it  a  small  quantity  of  lime 
water  or  soda.  Lime  water  in  such  combination, 
is  also  particularly  serviceable  in  cases  where  there 
exists  much  irritability  of  the  bowels,  and  tendency 
to  diarrhoea. 


156  TREATMENT 

Cream  diluted  with  warm  water,  and  a  little  pure 
sugar  added  to  it,  forms  often  a  bland  and  agreeable 
food  for  the  consumptive,  even  when  they  cannot 
bear  milk. 

In  the  United  States  of  America,  when  milk  is 
spoken  of  as  a  diet,  that  of  the  cow  is  generall}^ 
understood  to  be  meant ;  but  human  milk,  and  that 
of  asses  and  mares,  which  bears  a  near  resemblance', 
to  it,  enjoy  much  more  popular  repute  in  phthisis. 

The  varieties  of  milk  differ  especially  in  the 
relative  proportion  of  their  proximate  principles. 
Human  milk  is  sweeter  —  containing  more  sugar, — 
thinner,  of  a  bluer  color,  and,  according  to  Dr  Paris, 
yields  a  larger  proportion  of  cream  than  that  of  the 
cow,  but  the  butter  cannot  be  separated  from  its 
cream  by  agitation.  On  remaining  at  rest,  it  de- 
posits part  of  its  curd.  It  certainly  contains  more 
oily  matter  or  cream  than  the  milk  of  mares  or 
asses,  but  does  not  differ  materially,  in  respect  to 
this  constituent,  from  cowls'  milk;  its  proportion 
varying,  probably,  in  different  specimens  which  may 
be  compared. 

The  relative  amount  of  the  cream,  and  of  course 
the  other  constituents,  is  doubtless  much  influenced 
by  the  diet  of  the  individual.  In  females  who  are 
vigorous  and  eat  much  animal  food,  the  milk  be- 
comes very  rich  and  oily ;  and  it  has  been  found 
that  by  restricting  them  to  a  vegetable  diet,  the 
proportion  of  cream  becomes  manifestly  lessened. 

The  milk  of  asses  and  mares  nearly  resembles 
that  of  the  human  species  in  consistence,  color  and 


OF    CONSUMPTION.  157 

smell,  and  in  its  large  relative  amount  of  saccharine 
matter  when  compared  with  that  of  the  cow,  but  it 
contains  less  cream. 

Goats'  milk  affords  a  thick,  unctuous  cream,  but 
perhaps  less  in  quantity  than  that  of  the  cow,  or  at 
any  rate,  less  separates  from  the  other  constituents. 
But  the  diet  of  animals,  and  probably  other  circum- 
stances, must  of  course  more  or  less  influence  the 
character  of  this  secretion,  which  will  explain  the 
want  of  agreement  in  the  analyses  of  it  by  different 
chemists. 

Some  of  the  older  physicians  believed — and  the 
opinion  is  not  wholly  obsolete  at  the  present  day, — 
that  human  milk  was  the  diet  suited  above  all  others 
to  the  consumptive,  and  even  specific  virtues  would 
seem  to  have  been  attributed  to  it.  Hence  some 
remarkable  recoveries  from  consumption  have  been 
recorded  as  following  its  habitual  use ;  and  I  have 
in  mind  an  instance  published  in  one  of  our  modern 
medical  journals,  of  a  physician  who  asserted  that 
he  had  cured  himself  of  consumption  by  daily  suck- 
ing his  nursing  patients.  Perhaps  one  cause  of  this 
repute  of  human  milk,  may  have  been  the  difficulty 
of  obtaining  it ;  as  the  estimate  we  set  upon  an 
article  is  very  apt  to  be  in  proportion  to  its  scarcity. 
Its  analysis  certainly  affords  no  satisfactory  reasons 
for  a  superiority  in  consumption  over  the  other 
varieties  of  this  secretion.  For  obvious  reasons, 
however,  its  virtues  are  not  likely  to  be  brought 
fully  to  the  test  of  experience. 

Asses'  milk  is  certainly  a  very  good  diet  for  the 


158  TREATMENT 

consumptive,  and  from  its  being  somewhat  thinner 
and  weaker  than  that  of  the  cow,  may  have  some 
advantages  over  this  latter  in  cases  exhibiting  a 
marked  inflammatory  tendency.  It  may  be  pro- 
cm-ed  in  most  places  on  the  continent  of  Europe 
where  the  consumptive  are  in  the  habit  of  resorting. 
Madame  Starke — a  familiar  name  to  European 
travellers, — warns  us  that  in  purchasing  asses'  milk 
it  is  requisite  for  some  trusty  person  to  watch  the 
milking  of  the  ass,  to  prevent  the  infusion  of  hot 
water.  "The  man  who  milks  the  ass  usually 
carries,  under  his  cloak,  a  bottle  filled  with  hot 
water ;  some  of  which  he  contrives  to  mix  with  the 
milk  so  expertly,  that  it  is  difficult  to  detect  him." 

Goats'  milk  has  no  advantage,  of  which  I  am  aware, 
over  that  of  the  cow.  The  greater  ease,  however,  of 
obtaining  it,  causes  it  to  be  much  employed  by  con- 
sumptive travellers  in  Italy.  Goats  are  here  daily 
driven  about  the  cities,  to  the  doors,  or  even  apart- 
ments, if  required,  of  the  different  dwellings,  and 
the  milk  drawn  from  them  as  it  is  purchased.  Thus 
it  may  be  taken  warm  and  fresh  from  the  animal, 
in  which  state  it  is  especially  bland  and  digestible. 
It  is,  however,  occasionally  rendered  very  unpleasant 
from  the  impregnation  of  the  rank  exhalation  from 
the  goat. 

In  our  own  country,  the  milk  of  the  cow  is  in  by 
far  the  most  common  use ;  it  is  generally  agreeable 
to  the  palate,  and  affords,  for  the  most  part,  a  mild 
and  nutritious  diet  for  those  laboring  under  pul- 
monic difficulties.     When  the  circumstances  of  the 


OF    CONSUMPTION.  159 

case  render  it  too  nutritious  and  exciting,  it  may 
either  be  diluted  with  pure  water,  or  used  in  com- 
bination with  some  of  the  demulcent  vegetable 
decoctions.  Stale  light  bread,  or  biscuit,  may  of 
course  be  added  to  the  milk. 

Milk  boiled  and  thickened  with  some  farinaceous 
substance,  as  oatmeal,  rye  meal,  arrow  root,  &c., 
is  much  more  agreeable  to  some  persons  than  in  its 
pure  and  raw  state;  and  thus,  too,  the  constipating 
effect  produced  in  many  constitutions  by  crude  milk 
may  be  in  a  measure  avoided. 

Many  of  the  mild  subacid  fruits,  as  strawberries, 
raspberries,  oranges,  roasted  apples,  &c.,  from 
their  laxative  and  refrigerant  properties,  may,  if 
the  bowels  are  not  irritable,  be  admitted  with 
advantage  into  the  bill  of  fare  of  the  consumptive. 
Baked  sweet  apples  combined  with  milk  are  to  most 
people  a  very  grateful,  digestible,  and  somewhat 
laxative  diet. 

Whenever  any  inflammation  is  indicated  in  the 
lungs,  by  pain  in  the  chest,  heat  and  dryness  of  the 
skin,  frequent  and  strong  pulse,  or  when  there  is 
evidently  much  inflammatory  disposition,  a  strictly 
vegetable  diet  should  be  adhered  to,  and  of  the 
mildest  character,  as  decoctions  of  arrow  root,  tap- 
ioca, barley,  &c.,  with  biscuit;  or  such  substances 
may  be  made  into  plain,  light  puddings,  and  eaten 
sparingly. 

Several  demulcent  articles  are  in  common  use  in 
pulmonic  affections,  affording  a  bland  nourishment, 
and  at  the  same  time  tending  to  alleviate  the  cough 


160  TREATMENT 

by  soothing,  as  has  been  supposed,  the  irritation 
about  the  upper  part  of  the  windpipe.  Among 
them  may  be  particularized,  gum  arabic,  gum  trag- 
acanth,  and  Iceland  moss. 

Iceland  moss,  especially,  has  possessed  a  good 
deal  of  reputation  in  consumption,  for  its  demulcent, 
nutritive  and  gentle  tonic  properties.  When  its 
tonic  properties  are  not  desired,  it  may  be  deprived 
of  its  bitter  principle  by  repeated  washings,  or  by 
macerating  it  in  a  weak  alkaline  lie ;  it  then  acts 
like  any  other  mild,  mucilaginous  and  nutritious 
substance.  In  this  way  it  is  used  as  an  article  of 
diet  by  the  inhabitants  of  Iceland,  and  some  other 
parts  of  the  north  of  Europe.  To  prepare  it,  a  pint 
and  a  half  of  water  should  be  added  to  about  an 
ounce  and  a  half  of  the  moss,  and  boiled  down  to 
one  pint.  Of  this,  one  or  two  ounces  may  be  taken 
at  a  time,  either  alone  or  combined  with  milk,  with 
the  addition  of  a  little  sugar,  to  render  it  more  pal- 
atable. 

To  the  taste  of  many  persons,  these  vegetable 
demulcents  are  made  more  grateful  by  the  addition 
of  a  small  quantity  of  fresh  lemon  juice;  and  they 
may  be  rendered  slightly  laxative,  when  such  an 
effect  is  desirable,  by  boiling  with  them  sliced 
prunes  or  figs. 

There  are  a  few  other  articles  of  diet  which  have 
been  more  or  less  employed  in  consumption,  and 
hence  deserve  a  brief  notice. 

Raw,  new  laid  eggs  are  a  little  laxative,  and 
many  consumptive  persons  take  them  with  at  least 


OF   CONSUMPTION.  161 

apparent  impunity.  To  most  individuals  they  are 
more  pleasant  when  slightly  boiled.  If  boiled  hard 
they  become  extremely  indigestible.  In  some  per- 
sons, from  constitutional  peculiarity,  eggs  are  always 
difficult  to  digest,  and  by  such,  of  course,  should 
never  be  eaten.  Fresh  eggs  only  ought  to  be  em- 
ployed by  the  sick. 

A  few  varieties  of  shellfish  are  in  some  repute  as 
a  diet  in  consumption,  the  most  esteemed  of  which 
are  oysters.  These  are  a  favorite  article  of  diet, 
and  are  used  quite  freely  by  many  consumptive 
invalids.  They  are  most  digestible  when  taken 
directly  from  the  shell,  being  simply  warmed. 
That,  however,  they  possess  any  advantage  over, 
if  equal  to,  the  other  sorts  of  diet  recommended,  I 
am  by  no  means  satisfied.  Cooked  with  butter  and 
condiments,  they  are  very  difficult  of  digestion,  and 
in  this  way  should  never  be  eaten  by  the  sick. 
"Oysters,  in  my  opinion,"  says  Dr  Paris,  "enjoy  a 
reputation  which  they  do  not  deserve :  when  eaten 
cold,  they  are  frequently  distressing  to  weak  stom- 
achs, and  require  the  aid  of  pepper  as  a  stimulant ; 
and  since  they  are  usually  swallowed  without  mas- 
tication, the  stomach  has  an  additional  labor  to  per- 
form, in  order  to  reduce  them  into  chyme.  When 
cooked,  they  are  still  less  digestible,  on  account  of 
the  change  produced  upon  their  albuminous  prin- 
ciple. It  is,  however,  certain,  that  they  are  nour- 
ishing, and  contain  a  considerable  quantity  of 
nutritive  matter  in  a  small  compass."* 

•  On  Diet,  p.  111. 
21 


162  TREATMENT 

The  flesh  of  the  frog  has  had  considerable  esteem 
as  an  article  of  diet  in  phthisis,  and  I  have  known 
some  consumptive  subjects  to  become  very  partial 
to  it.  It  is  a  light  and  delicate  meat,  and  much  re- 
sembles that  of  the  tortoise.  The  thighs  and  legs  are 
alone  eaten.  In  the  United  States  frogs  are  scarcely 
regarded  as  an  article  of  food ;  but  in  France  they 
are  held  to  be  a  dainty  and  choice  dish,  and  can  be 
procured  only  at  a  very  high  price.  The  thighs 
are  there  eaten  fried,  fricasseed,  and  made  into 
soups.  They  are  of  a  peculiar  variety,  and  fattened 
in  a  particular  way  for  the  purpose ;  and,  though 
the  French  have  been  reproached  for  their  meanness 
in  eating  them,  they  are  a  luxury  too  expensive  to 
be  enjoyed  except  by  the  most  wealthy  epicures. 

Snails  have  likewise  been  advised  to  be  eaten  by 
the  consumptive.  The  snail  is  mostly  composed  of 
a  viscid,  slimy  matter,  readily  dissolved  in  milk  or 
water,  by  boiling,  giving  a  thick  mucilaginous  solu- 
tion. Hence  a  decoction  of  these  animals  may  form 
a  very  good  demulcent  diet.  They  are  occasionally 
employed  as  food  in  some  parts  of  Italy,  where  they 
abound ;  and  in  Sicily,  at  Cape  Passaro,  I  saw  them 
collected  and  eaten  with  wild  garlic  with  much 
apparent  relish.  If,  therefore,  a  consumptive  invalid 
is  disposed  to  eat  snails,  there  surely  can  be  no 
objection  to  it. 

We  fmd  also  recommended  in  some  of  the  older 
writers,  millepedes,  and  the  flesh  of  toads  and 
vipers,  but  as  such  substances  are  not  likely  to  be 
much  in  harmony  with  the  refinement  and  delicacy 


OF    CONSUMPTION.  163 

of  modern  tastes,  they  may  be  left  without  further 
remark. 

All  stimulatmg  drinks  are  of  course  to  be  avoided 
in  consumption.  Wine  is  only  admissible  in  rare 
instances,  and  under  particular  circumstances. 
When  a  fluid  diet  is  principally  taken,  but  little 
other  liquid  will  be  needed.  The  character  of  the 
drinks  ought  generally  to  be  mild  and  refrigerant, 
as  pure  water,  lemonade,  a  decoction  of  common 
balm  acidulated  with  lemon  acid,  &c.  As  alkaline 
medicines  have  been  in  considerable  repute  in 
phthisis,  though  without  any  definite  theory  of  their 
mode  of  action,  I  am  in  the  practice  of  advising,  as 
a  common  drink,  a  weak  solution  in  water  of  the 
carbonate  of  soda.  When  there  is  a  tendency  to 
acidity  in  the  stomach,  this  is  especially  useful. 
To  the  employment  of  weak  black  tea  or  cocoa,  in 
the  morning  and  at  night,  there  can  generally  be 
no  particular  objection. 


CHAPTER  XIV. 

TREATMENT    OF    CONSUMPTION    CONTINUED. 

Exercise  and  fresh  air.  —  There  is  no  remedy 
which  more  deservedly  holds  a  high  rank  in  the 
early  stage  of  consumption,  than  exercise  in  the 
open  air;  and  where  practicable,  therefore,  should 
never  be  neglected.     If  the  pursuits  are  sedentary, 


164  TREATMENT 

and  more  particularly  if  requiring  confinement  in  a 
close  atmosphere,  they  should  be  abandoned  on  the 
first  indications  of  the  disease,  and  a  large  propor- 
tion of  the  day,  when  the  weather  permits,  be  spent 
out  of  doors,  and  in  such  exercises  as  are  agreeable 
to  the  bodily  strength.  Were  I  required  to  mention 
the  remedy  which  promised  most  in  the  onset  of 
consumption,  I  should  say,  daily,  gentle  and  pro- 
tracted exercise  in  a  mild  and  equable  atmosphere. 

Exercise  and  pure  air,  by  invigorating  digestion 
and  all  the  functions  of  the  body,  must  consequently 
elevate  the  restorative  powers  of  the  constitution. 
The  frequent  inhalation,  too,  of  a  mild  air  into  the 
lungs,  may  not  improbably  exercise  some  healing 
influence  upon  them  when  only  slightly  and  par- 
tially diseased.  Exercise,  moreover,  determines 
the  blood  to  the  surface  of  the  body,  rendering  the 
cutaneous  function  more  active  and  healthful,  and 
may  in  this  way  also  contribute  to  the  advantage  of 
the  lungs. 

Though  exercise  in  the  open  air  may  not  be 
expected  to  cure  confirmed  phthisis,  yet  if  judiciously 
pursued  from  day  to  day,  the  strength  will  hold 
out  better,  the  individual  will  be  rendered  more 
comfortable,  will  retain  more  sources  of  enjoyment, 
and  his  existence  will  probably  be  longer  protracted 
than  it  would  have  been  under  confinement.  And, 
furthermore,  if  it  be  conjoined  with  prudence  in 
diet,  and  proper  regimen  in  all  other  respects,  and 
the  first  crop  of  tubercles  be  small,  the  living  and 
reacting  powers  may  be  so  much  elevated,  as  to 


OF    CONSUMPTION.  165 

bear  up  under  the  influence  of  the  disease,  and  a 
new  development  of  tubercles  may  be  delayed,  and 
in  some  rare  instances,  where  the  consumptive  pre- 
disposition is  not  strong,  may  even  be  permanently 
prevented. 

But  admitting  even  that  recovery  is  hopeless,  yet 
surely  it  is  no  trifling  blessing  for  one  destined  to 
linger  through  a  tedious  and  ultimately  fatal  malady, 
to  retain  in  some  measure  his  physical  powers,  his 
ability  to  help  himself,  and  daily  to  walk  or  ride 
abroad,  enjoying  the  cheerful  scenery  of  nature, 
and  experiencing  the  exhilarating  influence  of  mo- 
tion and  the  pure  air  of  heaven.  These  remarks 
are  of  course  not  applicable  to  the  very  acute  cases 
of  consumption,  but  to  those — constituting  by  far 
the  greater  proportion,  —  which  are  slow  in  their 
advances. 

The  muscular  powers,  though  the  disease  be  con- 
firmed, may,  by  a  regular  and  judicious  system  of 
exercise,  not  only  be  maintained  for  a  considerable 
period,  but  sometimes  even  become  augmented  by 
such  training.  Thus  I  have  known  consumptive 
subjects,  who  at  first  could  not  walk  half  a  mile  a 
day  without  experiencing  fatigue,  get  by  continued 
practice  to  walk  four,  five,  or  more,  with  perfect 
ease,  though  the  malady  was  all  the  while  gradually 
advancing.  In  a  few  rare  instances  I  have  even 
known  the  habit  of  walking  abroad  to  be  continued 
until  the  very  day  of  death. 

The  exercise  should  be  regular,  and  neither  so 
violent  nor  long  continued  as  to  create  exhaustion. 


166  TREATMENT 

The  practice  of  exercising  unduly  one  day,  and 
lying  by  the  next  to  recover  irom  the  fatigue,  is,  to 
say  the  least,  very  injudicious. 

Exercise  ought  not  to  be  taken  immediately  after 
eating,  unless  very  gentle,  and  the  meal  had  been 
sparing.  It  had  better,  too,  be  pursued  in  the  fore 
part  of  the  day,  when  the  sun  has  risen  so  high 
above  the  horizon  as  to  have  dispelled  the  damp 
vapors  which  form  during  the  night.  At  this  period, 
the  physical  capabilities,  even  in  health,  but  more 
particularly  in  organic  diseases,  are  usually  greater 
than  in  the  latter  part  of  the  day.  The  night  air 
should  always  be  shunned,  and  in  hot  weather,  ex- 
posure to  the  intense  rays  of  the  sun. 

During  exercise,  the  mind,  if  possible,  should  be 
pleasantly  engaged — not  left  to  brood  over  the 
infirmities  and  dangers  of  the  body.  Hence  the 
importance  of-  a  definite  and  interesting  pursuit,  as 
botany,  mineralogy,  or  some  other  branch  of  natural 
history ;  also  of  journeying  in  pleasant  countries, 
where  novel  scenes  and  objects  are  continually 
awakening  interest.  Hence,  too,  exercise,  if  solitary, 
is  generally  attended  with  less  advantage  than  when 
enjoyed  with  pleasant  company.  Man  is  a  social 
animal,  and  commonly  thrives  best  in  society.  In 
short,  exercise,  to  impart  all  its  benefits,  must  be 
made  a  pleasure,  not  a  task.  These  remarks  apply 
with  special  force  to  those  inclined  to  mental  de- 
pression. 

The  modes  of  exercise  are  to  be  suited  to  the 
tastes,  habits  and  powers  of  the  individual,  and 
varied  according  to  varying  circumstances. 


OF   CONSUMPTION.  167 

Walking.  —  When  the  bodily  vigor  is  sufficient, 
and  no  particular  circumstances  forbid,  walking 
should  form  at  least  a  part  of  the  daily  exercise.  It 
is  the  most  natural  mode  of  exercising  the  body, 
and  calling  all  the  muscular  system  into  active 
exertion,  maintains  the  general  physical  powers 
more  certainly  than  the  passive  motions.  Many 
other  arguments,  too,  might  be  adduced  in  its  favor. 
It  is  independent,  and  suited  to,  and  within  the 
reach  of  all  conditions  of  life.  Here,  at  least,  the 
poor  man  is  on  an  equal  footing  with  the  rich.  It 
can  be  taken,  too,  whenever  the  inclination  urges, 
unrestrained  by  the  will  or  convenience  of  others. 
How  often  it  happens  that  invalids  who  cannot  or 
will  not  walk,  are  compelled  to  forego  the  advan- 
tage of  fresh  air  and  exercise,  because  the  harness 
or  carriage  is  out  of  order,  or  the  horse  has  lost  a 
shoe,  is  lame,  or  cannot  be  spared;  or  the  father, 
or  brother,  or  husband  is  engaged,  or  does  not  feel 
in  the  mood.  But  to  no  such  impediments  is  walk- 
ing subjected. 

Walking  is  often  brought  into  disrepute  by  indi- 
viduals, perhaps  feeble  and  unused  to  it,  urging  it 
too  far  in  the  beginning.  The  physical  powers 
must  be  educated  to  it  by  commencing  moderately, 
pursuing  it  regularly,  and  gradually  increasing  it  in 
correspondence  with  the  increase  of  the  muscular 
capabilities.  Some  invalids,  however,  dislike  walk- 
ing, or  do  not  possess  bodily  vigor  to  protract  it 
sufficiently  to  obtain  the  necessary  exposure  to  the 
fresh  air,  and  of  course  must  resort  to  other  modes. 


] 68  TREATMENT 

I  am  inclined  to  think,  however,  that  many,  both 
sick  and  well,  omit  this  exercise  rather  from  indo- 
lence, or  defect  of  moral  energy,  than  lack  of  mus- 
cular power. 

Riding  on  horseback.  —  In  England,  horseback 
exercise  is  highly  esteemed  in  pulmonic  complaints. 
The  succussion  given  to  the  body,  united  with  the 
quick  passage  through  the  fresh  air,  seem  in  a  special 
manner  to  invigorate  the  pulmonary  function,  and 
to  afford  often  marked  relief  to  its  embarrassments. 
In  chronic  catarrhs  it  is  particularly  serviceable. 
This  exercise  can  be  longer  continued — when  once 
accustomed  to  it,  —  without  fatigue,  than  walking, 
thus  affording  the  important  advantage  of  protracted 
exposure  to  the  open  air  in  combination  with  pleas- 
ant exercise. 

Sydenham,  one  of  the  most  distinguished  of  the 
older  English  physicians,  looked  upon  horse- 
back exercise  as  a  particularly  efficient  remedy  in 
chronic  complaints  of  the  lungs.  Speaking  of  a 
cough  and  consumption,  he  says  —  "But  the  best 
remedy  hitherto  discovered  in  this  case,  is  riding 
sufficiently  long  journeys  on  horseback,  provided 
this  exercise  be  long  enough  continued :  observing 
that  the  middle  aged  must  persist  in  it  much  Ibnger 
than  children  or  young  persons.  For,  in  reality,  the 
Peruvian  bark  is  not  more  certainly  curative  of  an 
intermittent  fever,  than  riding  is  of  a  consumption, 
at  this  time  of  life."  And  in  another  place,  he 
says — "But  the  principal  assistant  in  the  cure  of 
this  disease,  is  riding  on  horseback  every  day ;   in- 


OF   CONSUMPTION.  169 

somuch  that  whoever  has  recourse  to  this  exercise 
in  order  to  his  cure,  need  not  be  tied  down  to 
observe  any  rules  in  point  of  diet,  nor  be  debarred 
any  kind  of  solid  or  liquid  aliment,  as  the  cure  de- 
pends wholly  upon  exercise." 

It  is  certainly  a  very  valuable  species  of  exercise 
in  pulmonic  complaints.  Long  journeys  pursued  on 
horseback,  through  pleasant  countries,  and  during 
the  warm  season,  are  often  of  peculiar  advantage  to 
those  strongly  predisposed  to  consumption,  and  may 
likewise  be  useful  in  its  incipient  stage,  particularly 
wheh  complicated  wuth  any  obstruction  in  the  liver. 
But  that  pulmonary  tubercles,  when  once  declared, 
and  to  any  considerable  extent,  can  be  cured  by 
horseback  riding,  no  one,  I  imagine,  will  at  the 
present  day  contend.  Coughs,  the  effect  of  simple 
pulmonary  catarrhs,  may  doubtless  often  yield  to  its 
salutary  influence,  and  as  the  older  physicians  drew 
no  nice  distinctions  between  them  and  consumption, 
we  may  easily  account  for  Sydenham's  faith  in  horse- 
back exercise  in  this  latter  disease. 

Riding  in  a  carriage,  and  swinging.  —  These  are 
more  gentle  exercises,  and  may  often  be  employed 
with  advantage,  particularly  by  those  who  are  too 
feeble  to  pursue  the  other  modes  which  have  been 
mentioned.  In  former  years,  considerable  efficacy 
was  attributed  to  the  motion  of  swinging  in  con- 
sumption. We  can  only  regard  it,  however,  as  a 
very  gentle  passive  exercise,  somewhat  analogous 
in  its  effects  to  that  of  sailing ;  and  when  it  affords 
22 


170  TREATMENT 

amusement  to  the  mind,  and  can  be  conducted  in 
the  open  air,  it  may  not  be  without  its  value. 

Inhalation  of  vapors,  or  volatile  substances,  and 
gases.  —  The  practice  of  inhaling  the  fumes  from 
different  resins  and  balsams  in  pulmonic  complaints, 
is  of  very  ancient  date;  and  within  a  few  years, 
breathing  the  vapor  of  heated  tar  has  been  brought 
into  some  repute  in  consumption,  especially  by  Sir 
Alexander  Crichton.  Dr  Beddoes  considered  a 
residence  in  a  cow  house  as  exercising  a  most  happy 
inlluence  in  the  cure  of  consumption,  which  he 
attributed  to  its  equable  temperature,  and  the 
effluvia  there  inhaled.  Van  Swieten  and  some 
others  have  attributed  virtue  to  the  odor  of  the  fresh 
earth  in  affections  of  the  lungs,  whence  the  employ- 
ment of  gardening  has  been  advised  in  them ;  and 
for  the  same  reason,  the  old  remedy  of  the  earth 
bath  was  approved  by  Van  Swieten.  This  consists 
in  burying  the  individual  up  to  the  chin  in  fresh 
mould.     It  is  not  in  use  at  the  present  day. 

The  great  immunity  from  consumption  enjoyed  by 
those  engaged  in  certain  occupations,  as  butchers, 
tanners,  tallow-chandlers,  brush-makers,  &c.,  has 
by  some  been  referred  to  the  influence  of  the  vapors 
and  gases  to  which  they  are  so  much  exposed.  The 
gas  arising  in  some  coal  mines  has  been  thought 
beneficial  in  the  disease ;  and  it  has  been  remarked 
that  the  miners  of  Cornwall  are  less  subject  to 
phthisis  than  most  other  persons.  Among  many  of 
our  country  people,  the  occupation  of  making  char- 
coal, or  tending  coal-pits  while  burning,  is  looked 


OF    CONSUMPTION.  171 

upon  as  very  serviceable  in  affections  of  the  lungs, 
the  benefit  being  attributed  to  the  fumes  given  off 
and  inhaled  during  the  slow  combustion  of  the  wood. 
The  clearing  of  new  lands  by  burning  them  over,  is 
likewise  an  employment  in  considerable  repute  in 
the  interior,  for  the  consumptive.  Here  smoke  is 
continually  inhaled  with  the  air,  and  is  imagined  to 
exercise  a  healing  influence  on  the  lungs.  Thackrah 
asserts  that  the  progress  of  consumption  is  not  so 
rapid  in  smoky  towns  as  in  the  pure  air  of  the 
country  and  the  mountains.* 

The  inhalation  of  watery  and  medicated  vapors, 
and  of  chlorine,  have  also  been  employed  in  phthisis, 
but  with  varying  results. 

Under  certain  modifications  of  consumption,  some 
of  these  means  may  act  as  palliatives  to  the  cough 
and  dyspnoea ;  still  I  imagine  that  most  of  the  in- 
stances which  have  derived  material  and  lasting 
benefit  from  them,  were  cases  merely  of  chronic 
pulmonary  catarrh.  In  some  instances  of  consump- 
tion, the  more  irritating  vapors  are  decidedly 
injurious,  and  have  even  occasioned  pulmonar}' 
hemorrhage.  The  steam  of  simple  warm  water  is 
sometimes  quite  soothing  to  the  lungs  when  irritable, 
and  the  cough  dry,  and  can,  at  any  rate,  be  produc- 
tive of  no  harm.  "When,"  observes  Dr  Clark, 
"the  air  of  a  consumptive  patient's  room  is  very 
dry,  the  cough  frequently  becomes  more  trouble- 
some, and  some  advantage  is  derived  from  a  basin 

*  Effi:ct3  of  Trades  on  Healtli 


172  TREATMENT 

of  warm  water  placed  near  the  patient ;  the  vapor 
diffuses  itself  in  the  air  of  the  chamber,  and  renders 
it  more  soothing  to  the  irritated  surfaces  of  the  air- 
passages,  while  it  saves  the  patient  the  irksome 
labor  of  inhaling." 


CHAPTER  XV. 

TREATMENT   OF    CONSUMPTION     CONTINUED. 

Sea  voyages. — Sea  voyaging  in  warm  latitudes,  I 
conceive  to  be  one  of  the  most  effective  means  in 
eradicating,  or  at  least,  keeping  dormant  the  tuber- 
culous disposition.  Phthisis  is  not  commonly  devel- 
oped, even  in  the  predisposed,  during  long  voyages, 
and  it  is  not  frequent  among  sailors  during  their 
seafaring  life.  Undertaken,  too,  on  the  first  indica- 
tion or  threatening  of  the  disease,  it  may  tend  to 
repress  its  development,  or  if  not,  to  alleviate  its 
symptoms,  and  protract  its  course.  Even  in  cases 
advanced  in  their  progress,  the  symptoms  are  not 
unfrequently  ameliorated  while  on  the  ocean,  though 
on  landing  they  commonly  return  with  all  their 
severity.  The  consumptive  should  always  voyage 
in  mild  seasons  or  latitudes,  so  that  all  the  benefit 
of  daily  exposure  to  the  equable  atmosphere  of  the 
ocean  may  be  experienced. 

In  those  cases  described,  where  the  disease  ad- 
vances very  slowly,  with  occasional  pauses  in  its 


OF    CONSUMPTION.  173 

course,  voyages,  especially  during  these  intervals  of 
activity,  may  often  be  undertaken  with  marked 
advantage. 

The  advantages  of  sea  voyaging  are  referrible  to 
several  causes.  It  is  associated  with  almost  con- 
stant muscular  exertion,  and  of  so  gentle  a  character, 
that,  w^hile  it  invigorates,  it  occasions  no  undue 
exhaustion  of  the  living  energies.  While  standing 
or  even  sitting  on  board  a  ship  in  motion,  a  con- 
tinued muscular  effort  is  demanded  to  maintain  the 
equilibrium  of  the  body,  and  which  will  be  propor- 
tioned to  the  degree  of  the  ship's  motion.  Hence 
the  muscular  weariness  and  sensation  of  uneasiness, 
or  even  pain,  i^n  the  back,  experienced,  especially 
towards  evening,  by  those  unaccustomed  to  the  sea. 
The  waddling  gait  of  sailors  on  first  landing  after  a 
long  voyage,  will  enable  us  to  form  some  estimate 
of  the  excess  of  muscular  exertion  demanded  to 
maintain  the  equilibrium  of  the  body  at  sea,  over 
that  which  is  necessary  on  shore.  When  the  sea  is 
rough,  and  the  ship  is  rolling  and  pitching,  there  is 
a  continued  action  of  numerous  muscles,  both  by 
day  and  night,  accompanied,  when  on  deck,  with  a 
sensation  similar  to  that  produced  by  swinging.  I 
conclude,  then,  that  one  of  the  benefits  of  voyaging 
is  probably  referrible  to  the  constant  muscular  exer- 
cise associated  with  it. 

The  moist  air,  slightly  impregnated  with  salt, 
which  is  constantly  inhaled,  may  likewise  aid  in 
soothing  the  function  of  respiration.  At  any  rate,  it 
is  apt  to  be  carried  on  more  quietly,  and  its  embar- 


174  TREATMENT 

rassments  are  often  greatly  alleviated,  whilst  sailing 
on  the  ocean. 

Sailing,  furthermore,  tends  to  diminish  the  circula- 
tion when  unduly  excited,  and  to  calm  and  equalise  it. 
It  also  quiets  the  nervous  system,  and  like  rocking 
and  similar  motions,  disposes  to  sleep.  Sailing  on 
the  Tiber  was  a  favorite  remedy  among  the  Romans 
in  chronic  complaints  of  the  lungs. 

The  influence  of  voyages  in  consumption  has  also 
been  attributed  in  a  large  measure  to  the  sea  sick- 
ness which  is  ordinarily  induced.  Sickness  and 
vomiting  are  generally  beneficial  in  chronic  inflam- 
mations of  the  lining  or  mucous  membrane  of  the 
air-passages,  and  may,  therefore,  afford  some  relief 
to  the  catarrhal  affection  which  is  apt  to  be  associated 
with  phthisis.  If,  too,  the  disease  were  complicated 
with  some  hepatic  obstruction,  or  other  disorder  of 
the  digestive  apparatus,  the  sea  sickness  might 
benefit  these  coincident  affections,  and  thus,  perhaps, 
indirectly  the  pulmonary  malady;  but  that  it  can 
exercise  any  direct  favorable  influence  over  the 
course  of  tubercles,  we  have  no  satisfactory  evi- 
dence ;  on  the  contrary,  if  severe  and  long  continued, 
by  greatly  reducing  the  living  powers,  it  might  be 
productive  of  serious  evil. 

The  equable  temperature  of  the  ocean,  doubtless 
contributes  much  to  the  advantage  of  voyaging. 
The  temperature,  when  out  of  soundings,  is  in  a 
great  measure  regulated  by  the  mass  of  waters, 
whose  range  of  heat  is  very  limited.  Hence  there 
is  an  exemption  from  the  influence  of  those  sudden 


OF    CONSUMPTION. 


175 


and  great  vicissitudes  of  heat  and  cold  so  common 
on  land — particularly  in  our  own  climate,  —  and  so 
extremely  prejudicial  in  all  descriptions  of  pulmonic 
complaints.  Thus,  persons  experiencing  much  em- 
barrassment of  respiration  when  on  the  seaside,  will 
often  be  very  sensibly  relieved  by  sailing  only  so 
far  from  the  shore  as  to  be  without  the  immediate 
influence  of  the  land  breezes. 

At  sea,  then,  in  a  proper  latitude,  the  invalid  can 
all  day  long  enjoy  the  benefit  of  exposure  to  a  pure 
and  equable  atmosphere,  which,  in  union  with  the 
continued  exercise,  exerts  the  most  happy  influence 
on  the  pulmonary  function.  To  take  cold  at  sea, 
when  out  of  soundings,  is  not  a  common  circum- 
stance, though  one  may  be  exposed*  to  bad  weather, 
to  the  night  air,  or  even  be  drenched  by  the  waters 
of  the  ocean.  But,  though  colds  are  rare,  they 
sometimes  happen ;  hence  invalids  should  always  be 
warmly  clad  when  exposed  on  deck  to  the  night  air 
or  inclement  weather. 

When  the  ship  arrives  on  soundings,  then  the 
vicissitudes  of  temperature  are  again  experienced, 
and  the  susceptiblity  of  the  body  to  their  influence 
being  augmented  from  having  become  habituated  to 
an  equable  atmosphere,  colds  and  their  train  of  evils 
are  very  common,  and  the  greatest  precaution  is 
necessary  on  the  part  of  the  invalid.  On  the  banks 
of  Newfoundland  the  weather  is  almost  always  cool, 
and  usually  foggy ;  hence  the  sudden  change  from 
the  mild  air  of  the  deep  blue  sea  to  this  chilly  and 
misty  atmosphere,  may  expose  the  consumptive  in- 


17()  TREATMENT 

valid  to  much  risk,  unless  he  cautiously  guards  his 
body  against  its  injurious  inlluence.  The  night  air 
should  be  here  particularly  avoided. 

From  vi^hat  has  been  said  it  will  be  understood 
why  small  islands  far  removed  from  the  mainland — 
other  things  being  alike,  —  afford  a  more  equable, 
and  consequently  better  climate,  in  pulmonic  com- 
plaints, than  continents,  or  islands  of  large  extent. 
Ever  as  the  influence  of  the  ocean  becomes  increased 
—  as  even  on  islands  in  our  harbors,  and  on  penin- 
sulas nearly  surrounded  by  a  large  extent  of  deep 
water, —  the  temperature  becomes  more  equable,  and 
the  effects  of  atmospheric  vicissitudes  consequently 
less  frequent.  Persons  who,  during  the  hot  season, 
are  in  the  habit  of  visiting  Nahant  —  a  peninsula 
extending  far  out  into  the  ocean,  —  must  have  noted 
how  little  subject  they  are,  while  there,  to  catarrhs, 
and  with  how  much  more  security  they  can  bear 
exposure  to  the  night  air,  than  in  the  neighboring 
city  of  Boston. 

There  is,  moreover,  something  associated  with 
the  moisture  of  the  sea  air — possibly  some  slight 
stimulating  effect  from  the  salt  dissolved  in  it, — 
which  renders  it  less  unhealthy  than  the  vapors  from 
fresh  water.  Hence  individuals  are  more  liable  to 
colds,  particularly  from  exposure  to  the  night  air, 
in  the  vicinity  of  our  large  lakes,  than  when  dwell- 
ing on  the  seacoast. 

It  may  be,  too,  that  some  principle  exists  in  solu- 
tion in  the  air  at  sea,  which  is  capable  of  exercising 
a  beneficial  influence  in   scrofulous  or  tuberculous 


OF    CONSUMPTION.  177 

constitutions.  I  have  already  remarked  that  alka- 
line medicines — a  solution  of  soda,  for  example, — 
have  enjoyed  considerable  reputation  in  tuberculous 
affections.  There  is  much  evidence  that  iodine  — 
a  peculiar  chemical  substance  obtained  from  kelp, 
and  probably  existing  in  very  minute  proportion  in 
the  waters  of  the  ocean, — possesses  some  healing 
influence  in  scrofula.  May  it  not  be  then — I  ad- 
vance it  but  as  a  mere  suggestion,  —  that  the  scrofu- 
lous and  tuberculous  owe  some  of  the  advantage 
which  they  often  derive  from  long  sea  voyages,  to 
the  soda,  and  perhaps  iodine  also,  which  exists  in 
solution  in  the  air,  being  taken  into  the  system  by 
absorption,  especially  through  the  medium  of  the 
lungs?  They  are  constantly  soaked,  as  it  were,  in 
a  sea  vapor  bath,  and  this  vapor  being  continually 
inhaled,  the  absorption  of  it  into  the  system  must 
be  uninterruptedly  going  on.  Those  tumors  on  the 
front  of  the  neck,  called  goitres,  and  which  have 
been  already  alluded  to  as  seeming  to  bear  some 
relationship  to  scrofula,  are  frequently  cured  by  sea 
voyages,  or  even  removing  from  the  interior  situa- 
tions where  they  prevail,  to  the  sea  shore.  They 
are  often  also  very  rapidly  absorbed  under  the  influ- 
ence of  iodine. 

The  salutary  effects  of  voyages  in  pulmonic  com- 
plaints, have  been  also  thought  to  be,  at  least, 
enhanced  by  the  smell  of  tar  and  resinous  substances 
used  about  the  ship ;  and  I  believe  it  was  this  sup- 
position that  first  suggested  the  inhalation  of  resinous 
fumes  in  consumption. 
23 


178  TREATMENT 

The  efl'cct  of  sea  voyaging  must  doubtless  vary 
more  or  less  in  different  constitutions,  some  deriving 
much  more  advantage  from  it  than  others.  Certain 
individuals  have  a  great  dislike,  or  even  dread  of 
the  ocean,  hence  care  little  for  their  food,  are  un- 
happy, and  perhaps  under  the  depressing  influence 
of  fear  all  the  time  they  are  on  shipboard.  Whether 
any  benefit  could  accrue  to  such,  would,  to  say  the 
least,  be  very  problematical.  In  some,  too,  the  sea 
sickness  is  so  very  extreme  and  lasting,  as  to  more 
than  counterbalance  all  the  advantages  which  have 
been  mentioned.  Most  voyagers,  however,  after  a 
time,  become  accustomed  to  their  new  mode  of  life, 
and  their  health  evidently  improves  under  it.  Still 
inconveniences  and  sufferings  are  to  be  anticipated 
at  sea  by  all,  and  are  often  most  keenly  felt  by  the 
sensitive  invalid,  causing  him,  at  first,  most  heartily 
to  repent  of  his  undertaking. 

As  one  of  the  greatest  evils  to  those  unaccustomed 
to  sailing  is  sea  sickness,  I  trust  it  will  not  be 
deemed  irrelevant  if  I  introduce  from  my  note  book 
a  few  observations,  made  while  at  sea,  on  this  dis- 
tressing affection. 

Sea  sickness.  —  Few,  save  veteran  sailors,  feel 
their  stomachs  as  undisturbed  when  the  ship  is 
rolling  and  pitching,  as  when  she  glides  smoothly 
through  the  water.  Even  though  vomiting  may  not 
ensue,  still  headach,  and  at  night  disturbed  sleep, 
and  perhaps  frightful  dreams,  will  often  afflict  those 
who  have  not  been  long  accustomed  to  the  sea. 
The  unnatural  motion  communicated  to  the  body 


OF    CONSUMPTION,  179 

very  likely  imparts  its  first  influence  to  the  brain 
and  the  stomach  becomes  secondarily  affected. 
Some  dizziness,  or  swimming,  as  it  is  often  termed, 
of  the  head,  almost  always  precedes  nausea  and 
vomiting.  The  vision,  too,  has  some  concern  in  the 
production  of  the  sickness,  since  looking  at  the 
water  when  rough,  or  when  the  ship  is  moving 
quickly  through  it,  may  produce  nausea,  or  add  to 
it  when  already  existing.  It  is  a  familiar  fact,  that 
in  some  persons,  sickness  is  very  speedily  excited 
by  looking  steadily  out  of  a  vehicle  in  motion,  on 
the  ground,  or  any  objects  by  which  it  is  rapidly 
passing.  Fixing  the  eyes  steadily,  even  when  the 
body  is  at  res.t,  on  objects  passing  swiftly  before 
them — a  train  of  steam  cars,  for  example — is  apt 
to  occasion  a  slight  vertigo,  and  if  continued  for  any 
length  of  time,  might  in  some  actually  produce 
nausea  and  vomiting.  The  motion  of  swinging  is 
much  like  that  of  sailing,  and  in  many  persons  very 
readily  induces  giddiness  and  nausea. 

There  is  a  very  marked  difference  in  different 
constitutions  in  the  facility  with  which  sickness  is 
occasioned  by  certain  motions  of  the  body.  Some 
cannot  even  ride  in  a  carriage,  especially  if  it  is 
close,  without  suffering  fi'om  nausea  and  vomiting. 
In  some  individuals,  sea  sickness  is  apt  to  be  very 
severe  and  protracted ;  whereas,  in  others,  it  is  but 
slight,  and  in  occasional  instances,  it  is  never  expe- 
rienced at  all.  I  have  observed  a  few  cases  in 
which  the  head  always  became  affected  with  pain 
and  vertigo  whenever  the  sea  was  rough,  though 


i80  TREATMENT 

nausea  and  vomiting  never  followed.  The  suscep- 
tibility to  sea  sickness  is  so  great  in  some  persons, 
that  the  slightest  motion  of  a  vessel  will  excite  it, 
or  perhaps  even  association  produced  by  the  odors 
from  the  ship,  or  the  creaking  of  the  spars  in  a 
calm. 

The  popular  remarks  made  on  this  sickness  would 
lead  to  the  belief  that  it  is  disfcioguished  in  its  amount 
of  suffering,  as  well  as  other  characters,  from  that 
following  most  other  causes.  But  I  imagine  that  the 
great  distress  and  depression  attending  it,  are  in  a 
principal  measure  referrible  to  the  lasting  operation 
of  its  cause,  from  which  there  is  no  escape,  and  its 
consequent  long  persistence.  Sickness  maintained 
for  a  definite  period  by  the  repeated  introduction 
of  small  portions  of  tobacco,  lobelia,  tartar  emetic, 
&,c,,  into  the  system,  would  probably  be  as  distress- 
ing as  that  produced  for  the  same  length  of  time  by 
a  ship's  motion. 

The  predisposing  cause  of  sea  sickness  is  inti- 
mately associated  with  the  physical  constitution,  and 
evades  our  most  searching  curiosity.  The  healthy 
and  robust,  with  vigorous  digestive  organs,  are  apt  to 
be  the  most  readily  and  severely  affected.  Dyspeptics 
many  times  either  escape  it  entirely,  or  experience 
it  but  in  a  slight  degree.  Thus  persons  laboring 
under  obstructions  of  the  liver,  or  other  derange- 
ments of  the  digestive  organs,  who  go  to  sea  antici- 
pating benefit  from  sea  sickness,  are  often  heard  to 
complain  that  they  cannot  vomit  freely. 

Some  consumptive  invalids  suffer  long  and  severely, 


s 


OF    CONSUMPTION.  181 

and  become  very  dangerously  reduced  by  sea  sick- 
ness; whereas  others  are  almost  or  entirely  free 
from  it. 

From  what  observation  I  have  had  opportunities 
to  make,  I  am  inclined  to  the  common  opinion  that 
females  are  more  apt  to  suffer  from  sea  sickness 
than  males.  Children,  from  the  ease  with  which 
they  vomit,  and  the  pliableness  of  their  systems, 
and  consequent  facility  of  adaptation  to  circum- 
stances, suffer  less,  and  sooner  recover  from  it, 
than  adults.  It  is  astonishing  to  observe  how  soon 
young  children  learn  to  adapt  the  action  of  their 
muscles  to  the  motion  of  the  ship !  Probably  the 
brain  and  other  internal  organs  become  educated 
with  equal  facility  to  the  new  circumstances  under 
which  they  exist. 

In  old  age,  the  nervous  sensibility  being  dimin- 
ished, there  usually  exists  less  susceptibility  to  this 
sickness  than  in  youth  or  adult  life. 

From  observations  on  the  subject — too  limited, 
however,  to  be  much  relied  on — I  have  been  inclined 
to  the  opinion  that  the  French,  and  I  may  add  also 
the  Italians,  are  more  obnoxious  to  sea  sickness  than 
the  English  or  Americans.  Do  the  former  possess 
a  higher  degree  of  nervous  susceptibility  than  the 
latter?  The  English,  however,  from  their  local 
situation,  are  most  of  them  from  early  life  much 
habituated  to  the  water. 

Habit,  sooner  or  later,  and  more  or  less  perfectly 
in  different  constitutions,  blunts  the  susceptibility  to 
the  affection  I  am  describing.     In  some  it  is  very 


182  TREATMENT 

aggravated  for  two  or  three  days,  then  ceases,  and 
is  not  again  experienced  during  the  whole  passage, 
be  it  longer  or  shorter.  In  others  it  will  last  a 
week  or  more;  and  again,  others  are  hardly  free 
from  it,  unless  when  the  sea  is  very  smooth,  until 
they  arrive  in  port.  The  disposition  to  it  is  in  some 
constitutions  entirely  eradicated  by  the  first  voyage, 
while  in  others,  more  or  less  sickness  is  experi- 
enced at  the  commencement,  at  least,  of  every 
succeeding  one. 

Some  persons  only  suffer  when  the  sea  is  very 
rough,  whereas  others  are  affected  by  the  slightest 
sensible  motion  of  the  ship.  When  the  waves  run 
high,  or  the  vessel  rolls  much  during  a  calm,  sick- 
ness is  apt  to  be  very  general  among  passengers. 
It  has  been  noticed  that  in  violent  storms,  w'hen 
actual  danger  is  present,  sea  sickness  will  often 
cease,  yielding  to  the  new  and  stronger  feeling  of 
terror. 

The  symptoms  are  much  the  same  as  in  sickness  at 
the  stomach  from  other  causes ;  yet  as  the  cause  is 
here  permanently  operative,  the  nausea  is  more 
constant,  more  depressing,  and  the  retching  more 
violent,  so  much  so  that  blood  is  in  some  instances 
actually  emitted  from  the  stomach.  Bile,  also,  is 
usually  vomited  in  greater  or  less  quantity;  not,  as 
is  commonly  imagined,  because  it  is  already  in  the 
stomach,  but  that  the  violent  and  inverted  action  of 
this  organ  is  extended  to  the  liver,  augmenting  the 
biliary  secretion,  and  drawing  it  by  means  of  this 
inverted  motion  into  its  own  cavity.     This  free  dis- 


OF    CONSUMPTION.  183 

charge  of  bile,  then,  is  for  the  most  part  merely  an 
effect  of  the  nausea  and  vomiting,  and  hence  is  likely 
to  be  serviceable  only  in  particular  cases  of  torpor 
and  obstruction  of  the  liver. 

In  some  constitutions,  every  thing  taken  into  the 
stomach  turns  to  an  intense  acid,  and  possibly  this 
organ  may  at  times  actually  secrete  an  acid.  Again, 
the  gastric  secretions  may  be  morbidly  acrid. 

The  whole  alimentary  canal  probably  partaking, 
in  a  degree,  in  the  inverted  action  of  the  stomach, 
and  but  little  consequently  passing  downward  from 
it,  natural  passages  by  the  bowels  become  very 
rare.  I  have  known  persons  to  cross  the  Atlantic 
without  having  a  single  intestinal  operation.  Con- 
stipation is  apt  to  be  very  troublesome  at  sea,  in 
many,  even,  who  are  not  at  all  affected  with 
sickness. 

The  suffering  from  sea  sickness  is  often  very 
extreme,  prostrating  all  the  energies  of  mind  and 
body,  so  that  the  individual  may  become  quite  reck- 
less of  his  fate ;  still  he  gets  but  little  pity,  or  per- 
haps is  even  made  the  subject  of  sport.  Our  strong 
sympathies  are,  for  the  most  part,  awakened  only 
by  those  diseases  which  are  supposed  actually  to 
threaten  life,  though  they  may  be  far  less  painful 
than  others  which  are  entirely  disregarded.  But 
such  is  the  instinct  of  our  nature — and  it  is,  doubt- 
less, in  reference  to  our  preservation,  —  that  sym- 
pathy should  be  especially  called  forth  where  life  is 
in  peril. 

Sea  sickness  has  in  some  rare  instances  proved 


184  TREATMENT 

fatal.  Should  there  exist  at  the  time  an  advanced 
aneurism  ol"  a  large  vessel,  as  of  the  aorta — the 
main  artery  conveying  the  blood  directly  from  the 
heart,  —  the  violent  straining  might  occasion  its 
rupture,  when  death  would  instantly  ensue.  So, 
too,  if  there  was  advanced  organic  disease  of  the 
heart,  or  of  any  other  highly  important  organ, 
excessive  vomiting  might  be  attended  with  fatal 
consequences. 

Aggravated  sea  sickness  is  always  dangerous 
when  there  exists  any  chronic  inflammation  of  the 
stomach  and  bowels;  and  even  where  they  are 
very  irritable,  and  disposed  to  inflammation.  In 
feeble,  nervous  habits,  as  in  delicate  and  irritable 
females,  although  it  sometimes  appears  to  improve 
the  health,  still  it  may  be  productive  of  serious  in- 
jury, or  at  least  of  an  exhaustion  of  the  vital  powers, 
from  which  a  long  period  may  be  required  to 
recover. 

When  the  vomiting  and  sickness  have  ceased,  the 
appetite  generally  becomes  very  keen,  digestion 
active,  and  the  subject  speedily  acquires  flesh  and 
vigor.  It  is  commonly  observed  that  the  health  is 
better  and  the  appetite  greater  where  free  vomiting 
has  taken  place,  than  when  nausea  alone,  or  perhaps 
with  some  slight  retching,  has  existed.  In  regard 
to  the  increase  of  appetite,  the  same  thing  happens 
after  other  affections  of  the  system  in  which  there 
had  been  great  waste  of  the  body,  with  but  scanty 
ingestion  to  supply  it ;  the  hunger  and  quick  diges- 
tion being  the  result  of  a  necessity  experienced  by 


OF    CONSUMPTION.  185 

the  system  in  its  wasted  state  for  new  and  rapid 
supplies.  The  pure  air  of  the  ocean,  and  continued 
exercise  communicate  also  an  additional  stimulation 
to  the  digestive  function. 

Treatment.  —  We  are  acquainted  with  no  remedy 
which  is  certainly  preventive  or  curative  of  sea 
sickness.  A  very  slight  experience  will  teach  us 
the  inefficacy  of  the  various  pretended  specifics. 
Most  persons  must  undergo  a  seasoning  on  ship- 
board, must  become  habituated  to  the  new  and 
unusual  motions  to  which  the  body  is  subjected, 
before  they  can  claim  exemption  from  this  distressing 
affliction ;  still,  by  a  judicious  care  of  diet  and  regi- 
men, not  a  little  may  be  done  to  mitigate  its  severity. 

Many  on  going  to  sea,  particularly  for  the  first 
time,  entertain  very  erroneous  notions  on  the  sub- 
ject of  their  diet.  They  imagine  that  the  stomach 
can  digest  almost  any  thing,  and  in  almost  any 
quantity,  and  that  the  more  substantially  they  fortify 
it  with  food,  the  less  will  be  the  chance  of  sea  sick- 
ness. The  consequence  is,  that  they  many  times 
begin  their  novel  mode  of  life  by  both  eating  and 
drinking  to  excess,  and  thus  the  stomach  becomes 
early  disordered,  and  sickness  is  not  only  more 
certainly  insured,  but  is  rendered  much  more  severe. 
I  have  seen  some  also,  during  the  intermission  of 
sickness,  and  return  of  appetite,  eat  all  sorts  of  in- 
digestible substances,  under  the  false  and  pernicious 
idea  that  cramming  was  their  best  remedy  against 
its  renewal.  But  the  offensive  articles  were  soon 
21 


186  TREATMENT 

rejected,  the  instinct  of  the  stomach  being  a  better 
guide  than  tlie  intellect  of  the  brain. 

It  should  ever  be  remembered  that  at  sea  there  is 
a  change  in  almost  all  our  habits,  that  we  live  under 
an  entirely  new  condition  of  things,  and  one  to 
which  time  alone  can  perfectly  adapt  our  systems. 
The  greatest  prudence,  therefore,  in  regard  to  diet  is 
at  first  particularly  demanded.  The  food  ought  to 
be  mild,  of  easy  digestion,  and  taken  only  in  moder- 
ate quantity.  On  board  of  our  packet  ships,  the 
meals  occurring  frequently — there  being  four  during 
the  day, — tempting  with  their  variety,  and  passengers 
having  little  other  employment,  they  often  eat  to 
pass  away  the  time.  Three  sparing  meals  a  day 
are  certainly  quite  enough  for  those  unused  to  the 
ocean. 

Wine  is  generally  injurious  to  those  disposed  to 
sea  sickness,  and  particularly  so  when  there  is  any 
tendency  to  acidity  of  the  stomach.  Under  the 
latter  circumstances,  the  light  acid  wines,  as  cham- 
pagne for  example,  are  in  a  special  manner  preju- 
dicial. Not  unusually,  the  morbid  effects  of  wine, 
as  acidity  of  the  stomach,  nausea  and  headach,  are 
principally  experienced  on  the  day  following  its 
employment. 

When  the  sickness  has  once  commenced,  then 
the  diet  should  be  of  the  most  mild  and  simple 
character.  Gruel,  arrow  root,  or  other  light  vege- 
table decoctions  with  biscuit,  or  black  tea  with  dry 
toast,  may  be  taken.  Sometimes  after  long  vomit- 
ing, a  few  mouthfuls  of  salted  meat,  or  codfish,  or 


OF    CONSUMPTION.  187 

pork  sliced  thin  and  fried  very  brown,  will  ope- 
rate as  grateful  stimulants  to  the  stomach,  pro- 
bably owing  to  the  salt  which  is  united  with  them. 
Not  unfrequently  a  burnt  crust  of  bread  in  water 
can  be  retained  better  than  any  thing  else.  It  too 
often  happens,  however,  when  the  sickness  is  severe, 
that  every  thing  swallowed  is  almost  immediately 
rejected. 

A  small  quantity  of  bland  food  taken  occasionally, 
is  oftentimes  serviceable,  by  involving  and  diluting 
the  morbid  and  irritating  secretions  of  the  stomach, 
and  thus  relieving  the  unpleasant  sensations  expe- 
rienced in  this  organ  from  their  action  on  its  delicate 
internal  surface.  A  little  mild  food,  too,  acting  as 
a  natural  stimulus,  tends  to  call  forth  the  healthful 
function  of  the  stomach.  When  food  is  taken  with 
the  special  view  to  relieve  nausea,  perhaps,  as  a 
general  rule,  solid — as  ship  bread  or  dry  toast, — 
is  better  than  liquid.  Fluids  should  always  be  taken 
in  very  small  quantities  at  a  time,  since  any  disten- 
tion of  the  stomach  by  them  in  its  irritable  state,  is 
apt  to  favor  the  vomiting. 

When  the  irritability  of  the  stomach  is  extreme, 
and  the  vomiting  urgent,  then  mucilaginous  fluids, 
as  decoctions  of  arrow  root,  tapioca,  barley,  &c., 
must  be  mainly  relied  upon  to  sooth  the  organ, 
and  afford  a  little  nourishment,  as  under  such  cir- 
cumstances, it  is  rare  that  any  solid  food  can  be 
digested. 

When  an  excess  of  acid  in  the  contents  of  the 
stomach  is  evinced,  it  may  be  readily  neutralized 


188  TREATMENT 

by  small  draughts  of  a  solution  of  the  carbonate  of 
soda  in  water,  or  the  common  soda  water ;  and  on 
the  other  hand,  when  there  is  much  vomiting  of  bile, 
and  the  gastric  matters  are  bitter  and  alkaline, 
small  quantities  of  lemonade  or  cider,  and  some  of 
the  subacid  fruits,  as  oranges,  grapes,  roasted  apples, 
may  be  employed  with  most  advantage.  Vegetable 
acids  are  much  esteemed  at  sea,  and  are,  for  the 
most  part,  pleasantly  stimulating,  very  grateful  to 
the  stomach,  and  not  uncommonly  relieve  slight 
nausea ;  but  when  that  sensation  denominated  heart 
burn  exists,  or  there  has  been  a  vomiting  of  acid 
matters,  then  they  are  rarely  proper. 

The  employment  of  active  medicines^ in  simple 
sea  sickness,  I  conceive  to  be  seldom  admissible, 
as  their  effect  is  more  frequently  to  aggravate  than 
to  quiet  the  disorder  of  the  stomach.  Opium  is 
sometimes  given,  but  though  its  immediate  action 
may  be  soothing,  yet  when  this  is  passed,  the 
stomach,  from  its  secondary  effects,  is  generally  left 
even  more  disturbed  and  irritable  than  previous  to 
its  administration.  Its  tendency  is  ever  to  impair 
more  or  less  the  digestive  powers,  and  to  aggravate 
the  constipation  of  the  bowels,  and  in  some  consti- 
tutions its  use  is  always  followed  by  sickness  of  the 
stomach.  This  medicine,  therefore,  is  only  allow^- 
able  in  those  extreme  cases  which  are  attended  with 
alarming  exhaustion,  or  with  much  pain  and  spas- 
modic action. 

In  some  instances  of  great  exhaustion,  mild  aro- 
matics  or  cordials,  as  peppermint  water,  warm  wine 


OF    CONSUMPTION.  189 

and  water,  &c.,  may  be  demanded.  Hot  punch 
and  spirits,  which  are  in  repute  among  some,  may 
afford  temporary  reUef,  but  their  ultimate  effects  are 
generally  prejudicial.  Friction  and  pressure  over 
the  stomach  with  the  hand,  may  sometimes  afford 
transient  relief  in  slight  nausea.  Compression  by 
means  of  a  broad  bandage  passed  round  the  abdo- 
men has  had  some  repute  as  a  remedy.  Sometimes 
it  does  appear  to  impart  a  little  relief,  but  at  others 
no  observable  benefit  results  from  it. 

The  fresh  air  is  always  highly  necessary  to  the 
sea  sick.  -  As  the  cabin  of  a  ship  cannot  with  facility 
be  thoroughly  ventilated,  and  the  air  in  it  is  conse- 
quently often,  very  close,  and  not  unfrequently 
tainted  with  the  peculiar  nauseating  odor  of  bilge 
water,  it  is  important  that  the  individual  should 
remain  on  deck  as  much  as  is  practicable ;  and  even 
when  the  sickness  is  so  severe  as  to  render  the 
horizontal  posture  requisite,  if  possible  it  had  better 
be  maintained  in  the  pure  air  above. 

Owing  to  the  change  of  diet  and  general  habits, 
and  to  some  circumstances  not  well  comprehended, 
constipation  of  the  bowels  is  apt  to  be  a  very  obsti- 
nate evil  at  sea;  hence  a  laxative  vegetable  diet, 
comprising  subacid  fruits,  stewed  prunes,  &c.,  it 
such  can  be  retained  on  the  stomach,  is  generally 
indicated.  The  occasional  employment,  too,  of 
mild  cathartics,  as  the  extract  of  butternut,  castor 
oil,  &c.,  or  mild  injections,  if  circumstances  admit, 
are  in  many  instances  demanded. 

I  have  simply  stated  the  general  principles  of 


190  TREATIMEXT 

management  in  sea  sickness,  wliich  may  of  course 
require  more  or  less  modification  in  different  cases. 
In  conclusion,  I  believe  I  may  safely  assert  that 
most  persons  who  make  up  their  minds  to  go  to  sea, 
must  also  make  u})  their  minds  to  suffer  more  or  less 
under  this  affliction ;  those  who  are  so  fortunate  as  to 
escape  it,  form  only  exceptions  to  the  general  rule. 


CHAPTER  XVI. 

TREATMENT     OF     CONSUMPTION     CONTINUED.  —  CHANGE     OF 
CLIMATE. 

General  remarks  on  the  influence  of  change  of  cli- 
mate.—  The  high  importance  of  fresh  air  and  daily 
exercise,  as  a  preventive  mean,  to  those  who  are 
predisposed  to  consumption,  and  as  a  remedy  for 
those  who  labor  under  its  threatening  symptoms,  is 
now  very  generally  acknowledged.  If,  therefore, 
the  climate  in  which  such  unfortunate  individuals 
reside,  is  so  bleak  and  variable  as  to  confine  them 
for  a  considerable  part  of  the  year  within  doors,  they 
should  surely  migrate,  at  least  during  the  cold 
season,  and  without  delay,  to  one  whose  skies  are 
more  genial,  and  where  these  inestimable  advan- 
tages—  air  and  exercise,  —  may  be  more  constantly 
enjoyed. 

There  are  also  other  modes  in  which  mild  climates 
may   favorably  influence    the  pulmonary   function. 


OF    CONSUMPTION.  191 

The  skin  and  liver  are  more  active  and  disposed  to 
disease  in  warm  than  in  cold  latitudes,  while  the 
reverse  is  true  in  regard  to  the  lungs.  As  previ- 
ously suggested,  the  cutaneous  function  does  appear, 
under  some  circumstances,  to  act  as  a  compensating 
power  to  that  of  the  lungs,  for  which  reason  its 
augmentation — and  perhaps  the  same  is  true  in 
regard  to  the  function  of  the  liver,  —  may  lessen  the 
demand  on  these  organs. 

Character  of  the  climate  to  be  selected.  —  The  climate 
aimed  at,  should  be  mild,  equable,  moderately 
moist,  and  still.  Hence  a  residence  in  sheltered 
valleys  is  preferable  to  one  on  hills.  A  dry  atmos- 
phere, as  usually  exists  on  elevated  lands,  rarely 
agrees  well  with  pulmonic  complaints.  A  very  hot 
climate,  too,  is  likely  to  hasten  the  advance  of  con- 
sumption, when  it  has  already  begun.  Hence  it 
may  be  comprehended  why  a  residence  which  might 
be  judiciously  chosen  for  winter,  would  form  a  very 
improper  one  during  the  summer. 

Laennec  and  a  few  other  physicians  have  advised 
that  an  abode  be  selected  near  the  seacoast,  that 
the  full  influence  of  the  sea  air — imagined  to  possess 
peculiar  virtues  in  the  disease,  —  may  be  experi- 
enced. On  small  islands,  and  on  capes  and  penin- 
sulas extending  far  into  the  ocean,  the  temperature 
being  more  or  less  under  the  controlling  influence 
of  that  of  the  waters,  must  enjoy  a  superior  equa- 
bility, and  the  air  also  be  maintained  in  a  uniform 
condition  of  moisture,  which  are  doubtless  advan- 
tages in  difliculties  of  the  lungs ;  but  whether  the 


192  TREATMENT 

ordinary  residences  near  tlie  seacoast  on  continents, 
or  extensive  islands,  possess  any  advantage  over 
those  in  the  interior  which  enjoy  an  equally  mild 
and  uniform  climate,  facts  and  observations  are  yet 
wanting  to  enable  us  to  judge.  Eminent  medical 
men  have  certainly  differed  much  in  opinion  on  this 
question. 

Though  I  have  stated  the  general  character  of 
the  climate  suitable  for  the  consumptive,  still  vary- 
ing circumstances  in  different  cases  may  demand 
somewhat  different  conditions  of  it.  Thus  some  are 
benefitted  by  a  degree  of  heat  which  to  others  would 
be  quite  prejudicial ;  and  though  a  moderately  moist 
atmosphere  is  generally  superior  to  a  dry  one,  yet 
exceptions  may  doubtless  occur.  Qualities  which  I 
deem  to  be  essential,  are  mildness  and  equability. 

But  now  comes  the  question — and  strange  as  it 
may  seem,  one  w^hich  has  never  been  settled, — 
where  on  the  face  of  earth  can  a  habitation  be  found, 
enjoying  in  perfection  the  conditions  required  in 
consumption  ?  Or  where  can  one  be  found  in  har- 
mony with  the  varying  and  irritable  feelings  of  all 
the  motley  groups  of  sensitive  invalids  who  yearly 
wander  forth  in  search  of  health  ?  It  is  ever  too 
hot  or  too  cold,  too  wet  or  too  dry ;  in  truth  elysium 
could  hardly  satisfy  them  all. 

The  opinions  of  the  sick,  in  regard  to  the  char- 
acter of  a  climate',  should  always  be  received  with 
a  good  deal  of  caution.  Their  bodies  are  apt  to  be 
morbidly  sensitive  —  readily  susceptible  to  the 
slightest    atmospheric   vicissitudes;     their    feelings 


OF    CONSUMPTION.  193 

often  irritable,  and  not  unusually  disappointed,  from 
having  indulged  in  too  high  anticipations  of  the 
perfection  and  remedial  power  of  distant  climes. 
Hence  may  be  explained  the  opposite  accounts  so 
frequently  given  of  the  same  climate  by  the  sick 
and  the  well.  Incidental  circumstances,  too,  as 
variation  of  seasons,  must  of  course  influence  the 
opinion  of  those  whose  residence  in  a  particular 
climate  is  but  temporary.  Travellers  are  far  too 
prone  to  draw  general  inferences  from  hasty  and 
insufficient  observations. 

The  results,  moreover,  derived  from  thermomet- 
rical  observations,  are  far  from  affording  a  true 
criterion  of  the  character  of  a  climate  in  its  relation 
to  the  human  body,  since  the  agitation  or  stillness 
of  the  air,  its  moisture  or  dryness,  materially  influ- 
ence the  rapidity  or  slowness  with  which  it  conducts 
off"  the  animal  temperature.  Our  bodies,  too,  will 
experience  an  influence  corresponding  to  the  sud- 
denness of  the  atmospheric  transitions,  whether  in 
regard  to  heat,  moisture,  or  motion.  It  is  plain, 
then,  that  our  sensations  can  by  no  means  be  accu- 
rately measured  by  the  rise  or  fall  of  the  mercury 
in  a  glass  tube. 

Banishing,  therefore,  all  idea  of  a  faultless  climate, 
we  have  only  to  make  the  best  selection — all  cir- 
cumstances taken  into  consideration, — which  our 
present  knowledge  renders  practicable. 

In  the  choice  of  a  climate,  it  is  a  matter  of  no 
little  importance  to  go  where  all  those  comforts  and 
attentions  so  necessary  to  the  sick,  may  be  readily 
25 


194  TREATMENT 

obtained,  and  furthermore  where  the  mind  can  find 
enough  of  occupation  and  amusement  to  prevent  it 
from  brooding  over  the  ills  of  the  body.  There  are 
doubtless  many  locations  in  different  parts  of  the 
earth  —  in  South  America,  for  example, — whose 
climate  is  far  superior  to  that  of  the  south  of  Europe, 
where  consumptive  invalids  are  so  much  in  the  prac- 
tice of  resorting.  But  then  the  country  being  mostly 
in  an  unsettled  condition,  and  the  requisite  comforts  of 
life  difficult  to  be  had,  the  advantages  of  the  climate 
are  more  than  counterbalanced  by  these  evils. 
Very  numerous  other  obstacles  may  also  stand  in 
the  way  of  a  selection  of  the  best  climate,  abstractly 
viewed,  even  though  it  be  known. 

For  those  who  are  inclined  to  mental  dejection, 
large  cities — for  reasons  too  obvious  to  need  re- 
peating,— will  generally  afford  more  favorable 
residences  than  small  and  obscure  towns. 

Period  when  change  of  climate  may  he  advisable. — 
There  can  be  little  question  in  regard  to  the  expe- 
diency of  a  change  of  climate  —  granting,  of  course, 
the  present  to  be  a  bad  one,  —  as  a  preventive  meas- 
ure in  those  who  are  scrofulous  and  predisposed  to 
consumption.  Thus  scrofulous  tumours  will  often- 
times quickly  diminish,  and  ulcers  of  the  same  char- 
acter heal  kindly,  under  the  assuasive  influence  of 
journeying  and  a  residence  in  southern  climes. 
And  I  have  already  asserted  that  tubercles  are  far 
less  apt  to  be  developed  under  mild  and  equable, 
than  under  cold  and  variable  skies. 

I  consider,  then,  that  individuals  dwelling  in  our 


OF    CONSUMPTION.  195 

northern  states,  and  who  are  satisfied  that  they 
labor  under  a  consumptive  predisposition,  owe  it  to 
their  ow*n  safety,  forthwith — not  staying  till  the 
malady  has  declared  itself,  —  to  remove  to  a  more 
southern  latitude,  there  to  pursue  their  occupations, 
and  there  to  establish  their  future  home.  I  am  fully 
persuaded  that  very  many,  by  seasonably  migrating 
to  a  softer  and  less  fickle  clime,  and  regarding  at 
the  same  time  those  preventive  rules  of  diet  and 
regimen  already  laid  down,  might  escape  the  un- 
timely grave  which  would  here  be  almost  inevitable. 
And,  taking  a  rational  view  of  the  case,  why  should 
one  sacrifice  health  and  life,  which  duty  so  imperi- 
ously commands  us  to  preserve,  to  local  ties  and 
associations.  In  youth — and  this  is  the  time  for 
removal,  —  these  may  easily  be  broken,  and  new 
ones  as  easily  created;  and  with  improvement  of 
health,  and  continuance  of  life  in  prospect,  additional 
happiness  may  be  reasonably  anticipated.  To  ob- 
tain to  any  extent  the  advantage  of  a  southern 
clime,  the  removal  should  be  as  far  as  the  southern 
part  of  Georgia,  or,  to  say  the  least,  as  far  as  South 
Carolina. 

When,  however,  the  disease  has  begun  to  develop 
itself — when  more  or  less  of  the  premonitory  signs 
mentioned  awaken  our  fears,  and  raise  the  suspicion 
that  the  tuberculous  disposition  is  quickening  into 
active  existence,  then  it  is  that  the  question  in 
regard  to  change  of  climate  becomes  one  the  most 
responsible  in  its  nature,  and  calling  for  the  utmost 
prudence  in  its  decision. 


196  TREATMENT 

I  am  apprehensive  that  some,  at  least,  of  the 
medical  profession  do  not  sufliciently  estimate  the 
weight  of  responsibility  they  incur  in  sending  their 
consumptive  patients  to  foreign  climes.  Before 
banishing  an  invalid  from  his  friends  and  home,  all 
the  circumstances  of  his  case  should  be  carefully 
investigated,  and  the  probabilities  of  advantage  from 
such  a  step  duly  calculated ;  and  after  all  it  is  but 
a  computation  of  chances,  in  which  the  best  informed 
and  most  judicious  may  at  times  err. 

In  making  up  an  opinion,  too,  on  this  subject, 
there  are  circumstances  unconnected  with  the  dis- 
ease, which  should  always  be  taken  into  the  account. 
If  a  person  had  wealth  to  command  all  the  atten- 
tions and  best  comforts  which  a  foreign  land  can 
afford,  we  might  with  less  hesitancy  advise  him  to 
the  step,  than  one  straitened  in  his  pecuniary 
means,  and  who  would  consequently  be  compelled 
to  endure  many  more  hardships  and  deprivations. 
The  feelings  and  habits  of  the  individual  are  also  to 
be  consulted.  One  who  enjoys,  and  is  accustomed 
to  travelling,  other  things  being  equal,  will  experi- 
ence less  difficulties,  and  derive  more  advantage 
from  it,  than  another,  whose  thoughts  and  wishes 
have  all  been  bounded  within  the  narrow  circle  of 
his  own  home.  The  latter  has  to  learn  to  travel, 
and  here,  as  in  every  other  instance,  experience 
must  be  bought  with  a  price. 

Sex,  moreover,  ought  to  influence  the  decision. 
Females,  from  their  nature,  as  well  as  the  customs 
of  society,  are  far  more  dependent  beings  than  our- 


OF    CONSU:\IPTION.  197 

selves.  Man  may  roam  the  seas  and  the  earth  at 
hispleasm-e;  hardship  and  change  are  his  enjoy- 
ment, and  the  world  his  home.  But  woman  is  more 
the  creature  of  domestic  life,  and  her  happiness  is 
more  intimately  blended  with  its  quiet  comforts  and 
tender  associations,  and  the  sacrifice  of  these — 
especially  when  her  body  is  sensitive  and  infirm, — 
often  casts  a  deep  shadow  over  all  her  feelings. 
Hence  to  her,  travel  is  ofttimes  a  painful  task — a 
series  of  inconveniences.  All  circumstances  of  the 
disease  then  being  alike,  it  might  be  proper  for  a 
male  to  go  abroad,  when  it  would  not  be  for  a 
female. 

It  is  no  easy  matter  to  designate  exactly  the 
period  and  circumstances  of  consumption  when  the 
experiment  of  change  of  climate  may  be  prudently 
tried,  and  here  we  can  do  no  more  than  approximate 
to  truth.  I  will  say,  then,  when  the  symptoms 
have  but  recently  begun  to  declare  themselves,  and 
are  slight,  when  there  is  a  little  cough,  some  trifling 
though  not  very  marked  disturbance  of  respiration, 
with  the  addition  of  some  dyspeptic  symptoms,  and 
commencing  emaciation,  or  if  there  had  been  a  pul- 
monary hemorrhage,  then  it  is  that  a  change  of 
climate  may  hold  out  a  chance,  at  least,  of  protract- 
ing existence;  and  though  it  be  but  a  chance,  if  no 
incidental  circumstances  forbid,  ought  it  not  to  be 
afforded  ?  Admit  it  to  be  but  as  one  to  four  or  five ; 
would  not  all,  life  being  the  stake,  wish  to  avail 
themselves  even  of  this  hazard  ?  At  such  period  of 
the  disease,  too,  journeying  is  ordinarily  well  sus- 


198  'rUIlATMKNT 

tained,  and  is  almost  invariably  associated  with  at 
least  a  temporary  increase  of  bodily  vigor. 

Furthermore,  if  on  a  cautious  examination  of  the 
chest  by  the  physical  means  now  in  use,  and  a 
critical  investigation  of  all  the  phenomena,  there  is 
reason  to  suspect  the  disease  to  be  limited  to  but  a 
small  portion  of  the  lungs,  then  change  of  climate, 
and  the  sailing  and  journeying,  one  or  both,  neces- 
sary to  effect  it,  may  assist  the  constitution  to  bear 
up  under  such  limited  disease,  and  to  oppose  a  new 
development  of  tubercles.  I  am  aware  that  it  is  no 
easy  matter  to  acquire  the  accuracy  of  knowledge 
in  regard  to  the  extent  of  the  malady  which  will 
here  be  needful,  yet,  disclaiming  any  pretension  to 
infallibility,  we  must  act  according  to  the  light  we 
possess. 

Again,  when  the  disease  is  manifestly  of  a  very 
chronic  character,  and  subject  to  interruptions  in  its 
symptoms  —  which  variety  I  have  described,  —  the 
subject  would  probably  be  rendered  more  comfort- 
able, and  live  longer,  in  a  mild  and  equable  climate, 
than  in  one  more  severe  and  variable. 

Though  the  importance  of  a  speedy  resort  to  the 
measure  under  consideration,  if  to  be  pursued  at 
all,  is  indisputable,  yet  it  too  often  happens  that 
the  slight  symptoms  frequently  marking  the  early 
dawn  of  the  malady,  are  regarded  as  of  insufficient 
moment  to  render  it  necessary.  The  occasion  is 
not  yet  urgent  enough  to  induce  the  unfortunate 
subjects  to  incur  the  expense,  trouble,  or  imagined 
danger  of  such  an  undertaking.     They  are  unwilling, 


OF    CONSUMrTIOX.  199 

for  an  illness  apparently  so  trifling,  and  which  they 
are  expecting  will  soon  pass  off,  to  forego  the  com- 
forts of  domestic  life — to  sever  the  ties  of  friendship 
and  kindred,  to  dwell  in  distant  and  unknown  lands. 
All  the  obstacles  and  sufferings  of  the  change  being 
magnified,  and  the  disease  flattering  them,  they 
wait  a  little  longer,  and  still  a  little  longer,  in  short, 
till  it  is  too  late,  and  then  they  are  willing  to  go — 
perhaps  do  go,  and  either  never  return,  or  experi- 
encing no  benefit,  hasten  back,  with  no  other  hope 
save  of  the  melancholy  satisfaction  of  dying  among 
their  friends.  It  is  this  procrastination  that  has 
tended  to  bring  into  disrepute  a  remedy  which  if 
seasonably  resorted  to,  might  many  times  be  pro- 
ductive of  the  most  happy  results. 

When,  therefore,  consumption  is  beyond  a  doubt 
established — when  its  existence  is  indicated  by  the 
various  signs  which  both  science  and  observation 
have  made  knowai  to  us  —  in  short,  w^hen  we  feel 
assured  that  tubercles  are  softening  or  suppurating, 
change  of  climate  affords  no  hope,  save,  perchance, 
in  those  rare  cases  before  specified,  where  the  crop 
of  tubercles  already  developed  is  imagined  to  be 
too  small  to  destroy  life,  or  in  which  the  disease  is 
very  chronic  and  intermitting.  With  such  excep- 
tions, it  may  not  only  be  useless,  but  may  really 
aggravate  the  disease,  and  hurry  its  fatal  ter- 
mination. 

There  are  incidental  circumstances,  too,  neces- 
sarily connected  with  this  change,  wdiich  must  be 
more  or  less  prejudicial  to  the  feeble  invalid.     As, 


200  TREATMENT 

for  example,  the  nervous  excitement  and  disturb- 
ance associated  with  the  preparations  for  a  removal 
to  a  distant  country.  The  agitation  and  moral  de- 
pression consequent  to  parting  with  friends,  kindred, 
home  and  native  land,  with  the  solemn  idea  weighing 
on  the  mind  that  the  separation  may  be  final. 
Moreover,  in  this  weak  and  dependent  state,  one 
feels  with  augmented  sensibility  the  privation  of 
those  nameless  little  attentions,  and  heartfelt  sym- 
pathies of  home,  which  smooth  the  sick  man's 
pillow,  calm  the  pains  of  disease,  and  render  even 
the  visage  of  death  less  frightful. 

Let  me  then  urge,  let  me  exhort  those  laboring 
under  manifest  consumption,  not  to  yield  up  their 
domestic  comforts,  and  the  last  melancholy  satisfac- 
tion of  breathing  out  their  life  amid  the  sympathies 
of  those  bound  to  them  by  the  most  endearing  ties, 
to  linger,  suffer  and  die  in  a  strange  land. 


CHAPTER  XVII. 

TREATMENT    OF    CONSUMPTION     CONTINUED. 

Directions  for  the  consumptive  travelling  to  the  south 
of  Europe.  —  As  the  invalid  in  a  foreign  land  stands 
in  need  of  numerous  little  comforts  and  attentions, 
which  may  easily  be  dispensed  with  in  health,  and 
which  money  alone  can  secure,  he  should  not  go 
abroad  without  a  sufficient  supply  of  this  necessary 


OF    CONSUMPTION.  201 

article.  If  the  sick  man  has  not  means  for  all  his 
necessities,  but  must  be  all  the  while  anxious  in  his 
mind,  and  contriving  or  perchance  even  quarrelling 
to  save  a  penny,  and  is  consequently  forced  to  debar 
himself  of  the  comforts,  and  may  be  even  of  the 
needful  accommodations  of  life,  he  had  far  better  be 
at  home.  No  invalid,  then,  should  decide  upon 
going  abroad  without  first  counting  the  cost,  and 
making  due  provisions  for  all  that  his  health  and 
comfort  may  require. 

Some  assured  friend  or  relative,  or,  in  defect  of 
such,  a  trusty  attendant,  should  always  accompany 
the  invalid  in  his  travels.  This  I  consider  of  essen- 
tial importance.  If  he  looks  to  strangers,  even 
though  they  be  his  own  countrymen,  for  attentions 
and  kindnesses,  he  will  too  often  find  himself  disap- 
pointed. The  company  of  the  sick  and  feeble  is 
apt  to  be  shunned  by  the  healthy  and  active,  who 
are  travelling  with  different  motives,  and  who  wish 
no  bar  to  the  freedom  of  their  movements,  and  the 
prosecution  of  their  pleasures.  The  services  of 
foreigners  to  the  sick,  as  might  be  suspected,  are 
commonly  heartless,  and  with  the  single  view  to 
gain.  Heaven  have  mercy  on  the  unhappy  stranger 
who  becomes  sick  and  helpless  in  the  south  of 
Europe,  with  no  friend  or  companion  to  look  to  for 
aid  or  consolation,  and  with,  perhaps,  but  an  im- 
perfect knowdedge  of  the  language  of  the  country! 
Those  who  have  unfortunately  experienced  such  a 
situation,  can  alone  tell  all  its  horrors.  But  if  to 
ihis  condition  is  added  straitened  pecuniary  cir- 
26 


202 


TREATMENT 


cumstances,  imagination  can  hardly  picture  greater 
misery. 

The  individual  should  be  well  furnished  with 
woollen  garments.  In  travelling  in  the  south  of 
Europe,  warm  clothing  will  be  found  especially 
needful  to  protect  the  body  against  the  great  transi- 
tions from  the  heat  of  the  valleys  to  the  cold  of 
the  mountains,  so  frequently  experienced  in  crossing 
the  numerous  Apennines.  Thick  clothing  is  needed 
even  as  far  south  as  Naples  and  Sicily,  with  occa- 
sional exceptions,  during  the  whole  of  the  winter, 
and  more  or  less  till  the  beginning  of  May. 

Before  the  consumptive  invalid  begins  a  voyage 
or  a  journey,  if  any  undue  excitement  or  an  inflam- 
matory disposition  is  manifested  in  his  system,  it 
should,  as  far  as  possible,  be  subdued ;  since  trav- 
elling, more  particularly  on  land,  often  adds  to  any 
excitement  which  may  already  exist.  Every  other 
morbid  affection,  too,  which  may  serve  to  compli- 
cate the  disease,  as  disorders  of  the  stomach,  liver, 
&c.,  should,  as  far  as  is  within  our  ability,  be  alle- 
viated. 

If  bound  for  Italy  by  the  way  of  France,  it  will 
be  necessary  to  embark  certainly  by  the  beginning 
of  August,  that  the  mountains  may  be  crossed  some 
time  during  the  month  of  September.  Should  cir- 
cumstances delay  a  departure  till  this  latter  month, 
it  will  be  more  prudent  to  sail  for  Leghorn,  Malta, 
or  some  port  in  Sicily,  for  which,  vessels  with  toler- 
able accommodations  may  usually  be  found,  either 
in  New  York  or  Boston.     The  most  weighty  objec- 


OF    CONSUMPTION.  203 

tion  to  this  course,  is  the  tedious  quarantine  to 
which  one  is  liable  to  be  subjected.  At  any  rate, 
the  consumptive  should  never  venture  crossing  the 
mountain  ranges  separating  France  from  Southern 
Italy,  later,  at  furthest,  than  the  early  part  of  Octo- 
ber. Mild  weather,  to  be  sure,  as  seasons  vary, 
may  be  experienced  on  the  mountains  beyond  this 
period,  still  there  is  hazard,  and  it  should  not  be 
adventured.  In  truth,  in  passing  the  high  points  of 
the  Alps  and  Apennines  at  the  most  favorable 
season,  more  or  less  vicissitudes  of  weather  are  to 
be  anticipated,  and  in  a  few  hours  even,  a  variety 
of  climates  may  be  experienced. 

The  most  usual  routes  pursued  in  travelling  from 
the  northern  part  of  France  into  Italy,  are  over 
Mount  Cenis  to  Turin  and  Genoa,  and  over  the 
Jura  Alps  and  the  Simplon  to  Milan.  The  latter  is 
the  more  northern  route,  somewhat  colder — the 
peaks  of  the  Simplon  being  covered  with  perpetual 
glaciers,  —  and  the  road  over  this  mountain,  when 
I  passed  it,  was  considerably  out  of  repair,  and 
generally  much  inferior  to  that  over  Mount  Cenis. 
Still  it  is  a  short  and  very  interesting  route,  and 
may  be  safely  taken  by  the  consumptive — if  their 
lungs  are  not  very  irritable,  and  the  day  is  fair  when 
they  cross  the  mountain,  —  in  summer,  or  the  first 
month  of  autumn.  If  October  has  commenced,  the 
passage  of  Mount  Cenis  should  be  preferred. 

A  route  still  further  south,  which  is  often  chosen, 
is  by  the  south  of  France  to  Marseilles,  thence  to 
Nice  in  Piedmont,  and  from  here  crossing  the  Mar- 


204  TREAT-MENT 

itime  Alps,  by  the  new  road  which  was  opened  for 
carriages  in  1827,  to  Genoa.  Should  the  invalid, 
on  arriving  at  Marseilles,  feel  himself  inadequate  to 
a  further  land  journey,  or  should  his  lungs  be  too 
irritable  to  endure  the  cold  of  the  mountains,  he 
may  generally  go  by  steamboat  to  Leghorn,  and 
from  this  latter  place — if  he  designs  proceeding 
directly  to  the  south  of  Italy,  —  in  the  same  manner 
to  Civita  Vecchia,  which  is  but  forty-seven  miles 
from  Rome ;  and  in  this  way,  the  mountainous  and 
tedious  journey  from  Florence  to  Rome  is  avoided. 
Some  delay,  however,  may  often  be  experienced 
from  the  irregularity  of  the  steamboats,  so  frequent 
on  the  Mediterranean. 

Circumstances,  however,  in  individual  cases,  must 
influence  more  or  less  the  decision  in  regard  to  the 
course  to  be  pursued.  Generally  when  one  is  in  a 
condition  to  undertake  the  journey  at  all,  the  moun- 
tains, if  not  later  than  September,  may  be  crossed 
with  safety. 

The  journey  itself,  indeed,  is  by  no  means  desti- 
tute of  advantage.  When  judiciously  conducted, 
and  the  weather  is  pleasant,  material  improvement 
in  the  health  will  often  be  experienced  from  its 
influence. 

In  journeying,  there  is  a  continued  succussion  of 
the  body,  and  a  constant  exposure  to,  and  passage 
through  the  fresh  air,  imparting  a  beneficial  influ- 
ence to  the  lungs  as  well  as  to  all  the  rest  of  the 
animal  economy.  The  mind,  too,  is  agreeabh'  ex- 
cited by  the  succession  of  new  objects  and  scenes  of 


OF    CONSUIMPTION. 


205 


interest  which  are  continually  presented  to  it,  and 
the  perplexities  of  business,  and  the  real  or  imag- 
inary cares  and  troubles  of  life,  are  to  a  greater  or 
less  extent,  banished  from  it.  Hope,  too — the  hope 
of  returning  health,  the  most  salutary  of  all  stimuli, 
which,  while  it  elevates  and  equalises  the  different 
functions,  leaves  no  exhaustion  behind,  —  is  at  the 
same  time  exercising  its  kindly  influence.  Hence, 
the  body  is  rendered  less  susceptible  to  atmospheric 
changes,  and  acquires  new  vigor,  the  appetite  im- 
proves, the  sleep  is  more  sound,  the  temper,  if 
previously  irritable,  becomes  more  even  and  cheerful, 
the  landscapes  of  nature  seem  more  gay,  life  holds 
out  brighter  promises,  and  the  pleasure  of  existence 
is  augmented.  Such  may  be  the  happy  results  of 
journeying,  if  sufficiently  long  continued,  and  rightly 
managed.  I  think,  therefore,  during  the  warm 
seasons,  the  consumptive  will  find  advantage  in 
making  frequent  changes  of  situation,  instead  of 
remaining  stationary. 

Journeying  and  continued  change  of  scene  are  in 
a  special  manner  beneficial  in  instances  where 
dyspepsia,  liver  complaints,  lowness  of  spirits,  irrita- 
bility of  temper  are  associated  with  the  predisposition 
to,  or  early  threatenings  of  the  disease. 

Travelling  should  always  be  so  conducted  by  the 
invalid  that  neither  his  mind  or  body  be  overwrought. 
In  regard  to  the  mind,  it  is  proper  that  it  be  amused 
and  pleasantly  excited,  but  it  should  never  be 
fatigued.  Italy,  in  a  particular  manner,  so  abounds 
in  objects  awakening  the  most  eager  curiosity,  and 


206  TREATMENT 

interesting  associations,  that  there  is  constant 
hazard  of  undue  mental  and  physical  exertion. 
Few  labors  are  more  fatiguing  to  one  in  health  — 
and  how  much  more  so  must  they  be  to  the  feeble 
and  infirm?  —  than  a  continued  routine  of  sight  see- 
ing. The  powers  of  both  mind  and  body  are  often 
thus  drawn  upon  to  excess  during  the  day,  and  at 
night  the  individual  finds  himself  in  too  high  a  state 
of  moral  excitement  and  nervous  irritability  readily 
to  compose  himself  to  rest.  This  is  more  especially 
apt  to  happen  in  the  large  cities  of  Italy.  The 
principal  exertions  of  the  invalid  should  be  made 
in  the  fore  part  of  the  day,  thus  affording  time 
for  the  consequent  nervous  disturbance  to  become 
quiet  previous  to  retiring  to  repose  at  night. 

Natural  scenery  always  tasks  the  mind  far  less 
than  the  works  of  art,  since  while  it  delights,  it 
commonly  imparts  serenity  to  the  feelings. 

Travelling  for  health,  then,  and  travelling  for 
instruction,  are  very  different  things,  and  are  to  be 
very  differently  conducted. 

It  is  equally  important  that  undue  physical,  as 
that  undue  moral  labor  be  avoided.  The  invalid 
should  ever  travel  at  his  ease.  Let  the  system  be 
pleasantly  excited  by  exercise,  but  never  exhausted 
by  fatigue,  and  more  especially  at  unseasonable 
hours.  Hence  the  practice  of  travelling  all  night, 
or  even  for  successive  nights,  in  a  malU  poste  or 
diligence,  is  greatly  to  be  reprobated.  The  regular 
hours  of  sleep  should  be  scrupulously  observed,  and 
the  night  air  carefully  shunned  by  the  consumptive. 


OF    CONSUMPTION.  207 

I  would,  in  a  special  manner,  warn  the  consump- 
tive, whether  journeying  or  stationary,  of  the  danger 
of  visiting  the  churches  of  Italy.     These  are  almost 
always   cold  and  damp,  and  occasion  a  chill  like 
that  experienced  on  entering  a  cave  or  cellar  in  the 
summer  season.     The  feet,  too,  unless  thick  shoes 
are  worn,  are  apt  to  suffer  from  exposure  to  their 
cold   marble   floors.     The  risk  is   also  increased, 
owing  to  the  necessity,  imposed  by  religious  custom, 
of  visiting  them  bareheaded.     A  person  in  health, 
even,  cannot  remain  long  in  them  without  suffering 
from    their    chilling    influence.     The    consumptive 
invalid,  then,  should  never  enter  these  places  unless 
his  body  is  well  guarded  by  warm  clothing,  and  his 
head  protected'  by  a  handkerchief,  or   some  other 
unforbidden  covering.     The  church  of  St  Peter,  at 
Rome,  however,  affords  an  exception  to  these  re- 
marks.    Owing,  probably,  to  its  immense  size,  its 
air  is  generally  mild  and  pleasant,  and  its  yearly 
range  of  temperature  is  only  about  ten  degrees. 

In  regard  to  the  different  modes  of  travelling  in 
the  south  of  Europe,  the  most  eligible  and  inde- 
pendent is  posting  in  one's  own  carriage.  By  this 
method,  the  routes,  stopping  places,  periods  of 
travelling  and  rest,  may  all  be  adjusted  to  suit  the 
ability  and  convenience  of  the  individual ;  and  it  will 
be  found  of  no  trifling  moment  to  the  feeble  in 
health  to  have  it  in  their  power  to  rest  when  they 
please,  and  to  stop  where  they  can  enjoy  the  most 
suitable  accommodations;  for  really  a  mean,  dirty 


208  TREATMENT 

Italian  albergo,  is  no  place  for  a  delicate  and   sus- 
ceptible invalid. 

Another  cheaper  and  very  customary  manner  of 
travelling,  is  in  a  vcttura.  This  is  much  slower 
than  posting,  there  being  no  change  of  horses.  The 
daily  distance  ordinarily  travelled  in  this  way,  is 
from  thirty  to  forty  miles ;  hence  one  must  be  on 
the  road  for  long  continued  periods.  As,  too,  the 
vctturino,  or  driver,  is  obliged  to  accomplish  fixed 
daily  tasks,  and  often  with  dull  horses,  he  will 
usually,  unless  a  definite  bargain  is  made  to  the 
contrary,  set  out  very  early  in  the  morning,  and  is 
not  unfrequently  driven  to  encroach  more  or  less 
on  the  evening.  Only  one  stop  is  made  during  the 
the  day,  which  is  about  noon,  for  the  purpose  of 
refreshing  the  horses,  and  allowing  a  dejeuner  a  la 
fourchette  to  the  passengers.  This  is  commonly 
protracted  about  two  hours,  sometimes  longer,  and 
is  not  unfrequently  in  the  very  last  place  one  would 
have  selected  for  so  tedious  a  delay.  As,  too,  the 
daily  distances  must  be  as  equally  divided  as  possible, 
the  advantage  of  the  best  lodgings  for  the  night 
cannot  always  be  enjoyed.  By  making,  however, 
a  definite  contract,  and  paying,  of  course,  an  extra 
price,  some  of  these  evils  may  be  avoided ;  and  the 
individual  who  cannot  afford  posting,  and  is  content 
to  journey  slow,  may  thus  get  along  with  a  tolerable 
degree  of  comfort.  A  written  contract  should 
always  be  made  with  a  vetturino,  and  all  the  articles 
of  it  carefully  specified. 

Those  rules  of  diet  and  regimen  w'hich  I  have 


OF    CONSUMPTION.  209 

already  stated,  are  all,  as  far  as  practicable,  to  be 
observed  while  travelling.  Many  persons  entertain 
the  false  idea  that  when  journeying  there  is  no 
longer  necessity  for  restricting  themselves  in  regard 
to  their  food  or  drink ;  but  if  the  consumptive  trav- 
eller, under  such  belief,  indulges  his  appetite  without 
restraint,  the  digestive  function  will  probably  soon 
become  deranged,  and  the  pulmonic  symptoms  con- 
sequently aggravated;  thus  the  advantages  of  jour- 
neying will  be  forfeited,  and  even  the  measure  itself 
may  be  brought  into  unmerited  reproach. 

Frequent  meals,  when  travelling,  are,  to  say  the 
least,  quite  unnecessary.  When  riding  constantly, 
one  can  usually  fast  longer  without  experiencing 
that  peculiar  faintness  at  the  stomach,  the  result  of 
abstinence,  than  while  idling  about  at  home.  As  a 
general  rule,  the  consumptive  traveller  had  better 
take  his  breakfast  previous  to  setting  out  in  the 
morning,  and  dispense  with  the  regular  meal  about 
noon  —  the  dejeuner  a  la  fourchette — so  common  in 
France  and  Italy,  and  take  in  its  stead,  if  food  be 
needed,  a  little  bread  and  milk,  maccaroni,  or  fruit. 

The  day's  journey  ought  to  be  concluded  before 
sunset,  and  only  a  plain  and  frugal  repast  taken. 
The  not  unfrequent  practice  of  dining  at  eight  or 
nine  in  the  evening,  and  almost  immediately  after 
retiring  to  bed,  is  surely  improper  for  the  invalid. 

Those  persons  who,  laboring  only  under  the 
tuberculous  predisposition,  are  travelling  as  a  pre- 
ventive mean,  may  take  a  proportion  of  solid  animal 
food,  and  perhaps  with  safety  indulge  in  a  sparing 
27 


210  TREATMENT 

use  of  the  light  wines  of  France  and  Italy  ;  but  by 
those  in  whom  the  symptoms  of  consumption  have 
begun  to  manifest  themselves — most  certainly  if 
there  exists  an  inflammatory  tendency, — both  wine 
and  solid  animal  food  had,  as  a  general  rule,  better 
be  forborne. 

When  journeying  in  Italy,  the  invalid  should  not 
cross  the  Campagna  di  Roma  or  the  Pontine  marshes 
either  early  in  the  morning,  before  the  sun  has 
risen  sufficiently  high  to  have  dispelled  the  damp 
vapors  which  condense  upon  them  during  the  night, 
nor  toward  evening,  when  the  formation  of  these 
vapors  has  begun,  since  then,  especially,  the  air 
becomes  chilling  and  poisonous.  Generally,  in 
passing  these  unhealthful  situations,  additional  gar- 
ments are  needed,  and  unless  the  sun  is  high  and 
warm,  the  carriage  should  at  least  be  partially 
closed.  The  Italian  travellers  well  understand 
their  deleterious  character,  and  hence  on  arriving 
upon  them,  particularly  toward  nightfall,  wrap  their 
cloaks  about  them,  draw  up  the  carriage  windows, 
and  shuddering  exclaim,  aria  cattiva!  All  the 
peasantry,  too,  seen  here  toward  evening,  are 
closely  muffled  in  their  cloaks,  or  protected  by  the 
skins  of  their  flocks.  But  I  will  employ  a  few  mo- 
ments—  and  I  trust  the  digression  will  be  pardoned, 
—  in  a  cursory  description  of  these  places,  so  long 
noted  for  their  unhealthfulness. 

The  Campagna  encircles  Rome,  and  hence  is 
necessarily  crossed  in  going  to  this  city  in  any 
direction.     It  is  something  more  than  a  hundred 


OF    CONSUMPTION. 


211 


miles  in  extent,  and  its  surface  somewhat  undulating, 
—  its  soil  is  a  sandy  loam,  covered  with  a  green  turf, 
and  here  and  there  may  be  seen  the  bramble,  gen- 
ista or   broom,  gorse,    thistle,   wild  poppy,   some 
shrub  oaks,  &c.     It  is  destitute  of  trees,  and  even 
its  shrubbery  is  not  very  abundant.     Occasionally  a 
little  stagnant  water  may  be  observed,  yet  it  is,  for 
the  most  part,  dry,  and  resembles  an  extensive  and 
desolate  heath.     Its   uniform   expanse,    especially 
when  seen  through  a  hazy  atmosphere,  bears  no 
little  resemblance  to  the  sea  itself.     Only   a  few 
acres  of  its  soil  appear  to  be  reduced  to  cultivation, 
and  though  in  the  proud  days  of  Rome  so  populous, 
it  now  scarcely  comprises  a  thousand   inhabitants, 
and  these  poor  and  sickly,  and  instead  of  clustering 
together  in  cheerful  villages,  are  seen  scattered  only 
at  distant  intervals  over  this  lonely  waste.     Silence 
and  desolation  are  its  melancholy  characteristics, 
and  every  thing  seems  ominous  of  its  threatening 
character.     Few  objects  here  meet   the  eye,  save 
the  solitary  post  house,  or  the  miserable  hut  of  some 
wretched  shepherd  or  herdsman,  or  a  dreary  ruin 
rising  amid  the  solitude — a  remnant  of  other  ages, 
and  a  monument  of  departed  power. 

In  the  atmosphere  of  the  Campagna  there  exists 
a  mysterious  poison,  supposed  to  arise  from  its  soil, 
termed  malaria,  so  fatal  to  human  health  and  life, 
that  man  cannot  long  withstand  its  influence.  It  is 
insensible,  and  consequently  known  only  by  its 
effects ;  and  in  the  aspect  of  the  soil  there  is  nothing 
to  indicate  its  production.     It  appears  to  become 


212  TREATMENT 

more  concentrated,  and  of  consequence  more  highly 
active  at  night  than  during  the  day. 

The  Pontine  marshes  are  situated  about  forty 
miles  south  of  Rome,  and  on  the  way  to  Naples. 
Their  name — Paludes  Pomptinaj,  —  is  derived  from 
Pometia,  w^hich  was  a  very  considerable  town  ante- 
rior to  the  foundation  of  Rome,  and  was  seated  in 
their  vicinity.  These  marshes  extend  about  twenty - 
four  miles  in  length,  and  vary  from  six  to  twelve  in 
breadth.  They  are  bounded  on  one  side,  or  the 
west,  by  the  Mediterranean  sea,  and  on  the  other 
the  Apennines  sweep  round  them  with  a  graceful 
curve.  At  their  southern  and  western  extremity  is 
seen  the  lofty  and  classical  promontory  of  Circello, 
the  fabled  residence  of  Circe,  daughter  of  the  sun. 

From  the  time  of  Appius  Claudius,  who  con- 
structed the  celebrated  Appian  Way,  the  efforts  and 
ambition  of  emperors  and  popes  seem  to  have  been 
more  or  less  directed  to  the  draining  and  rendering 
salubrious  these  pestiferous  fens ;  hence  dikes  and 
canals  are  seen  almost  every  where  passing  through 
them,  designed  to  collect  the  waters  descending 
from  the  neighboring  mountains,  and  convey  them 
to  the  sea. 

Though  they  are  denominated  marshes,  yet  their 
northern  portions,  certainly,  more  resemble  rich 
meadow  lands.  As,  however,  we  advance  south, 
they  exhibit  in  a  greater  degree  the  characters  of  a 
marsh ;  much  sluggish  and  standing  water  is  seen, 
and  often  covered  with  an  abundance  of  a  green 
vegetable  scum ;  and  numerous  streams  are  observed 


OF    CO?^  SUMPTION.  213 

passing  over,  or  slowly  winding  their  course  through 
a  rank  growth  of  vegetable  matter  peculiar  to 
marshes,  as  the  reed,  flag,  bulrush,  &c. 

The  soil  of  the  Pontine  marshes  is  a  little  undu- 
lating and  broken,  and  consists  of  a  dark,  and  in 
some  spots,  of  a  reddish  or  yellowish  loam.  Much 
of  it  is  now  reduced  to  cultivation,  and  fields  of 
grain,  and  rich  pastures  covered  with  horses,  oxen 
and  herds  of  buffaloes,  meet  the  eye  in  every 
direction. 

These  grounds  are  even  more  destitute  of  popu- 
lation than  the  Campagna.  Save  the  lonely  post 
house,  the  straw  shelter  of  the  laborer,  and  the 
guard  house  of  .the  soldier,  at  its  regular  intervals, 
no  signs  of  human  habitation  cheer  the  view.  The 
peasants  dare  not  sleep  here,  but  when  the  vapors 
of  night  begin  to  condense  upon  the  plains,  retire  to 
their  villages  on  the  mountain  sides,  and  in  the 
morning  descend  again  to  their  labors.  The  soldier 
condemned  to  this  dangerous  spot  as  a  safeguard  to 
the  traveller,  is  almost  the  only  permanent  resident ; 
and  toward  evening,  fires  are  seen  blazing  about 
his  dwelling,  as  a  security  against  the  poisonous 
influence  of  the  malaria. 

As  with  the  Campagna,  there  is  associated  with 
these  luxuriant  plains  a  subtile  and  inscrutable 
poison,  highly  deleterious  to  moral  energy,  health 
and  human  life,  and  which  is  more  particularly 
active  at  night.  An  unpleasant  odor  is  sometimes 
perceived  here  toward  evening,  similar  to  what  I 
have   occasionally   experienced    in   passing    some 


214  TREATMENT 

marshes  in  our  own  country  which   are  associated 
with  the  production  of"  agues. 

It  is  a  common  opinion  that  the  air  here  occa- 
sions drowsiness.  All  I  can  say  on  this  subject  is, 
that  the  first  time  I  passed  these  marshes,  the  three 
persons  in  the  coach  beside  myself,  were  sleeping 
most  of  the  time,  and  that  I  felt  not  a  little  inclined 
to  do  the  like.  It  should  be  considered,  however, 
that  travellers  are  apt  to  be  very  early  risers. 

The  road  over  these  grounds  is  remarkably  fine, 
broad  and  dry,  and  built  upon  the  foundations  of  the 
old  Appian  Way. 

When  the  invalid  has  arrived  where  he  designs 
spending  the  winter,  a  matter  of  no  small  consider- 
ation is  that  comfortable  lodgings  be  secured,  else 
all  the  kindly  influence  of  milder  skies  may  be 
counteracted.  It  is  not  unusual  for  persons  who 
migrate  for  the  winter  to  more  southern  latitudes, 
actually  to  suffer  more  from  cold  than  they  would 
have  done  at  home.  In  the  south  of  Europe — and 
the  like  is  true  wherever  the  hot  weather  much  ex- 
ceeds the  cold,  —  the  dwellings  are  all  planned  to 
afford  defence  against  the  heat ;  hence  the  floors 
are  commonly  of  tile  or  marble,  and  without  carpets; 
the  entries  and  staircases  spacious  and  airy,  ar.d 
the  fireplaces,  when  there  are  any,  seem  rather 
constructed  to  retain  than  to  transmit  the  heat. 
The  apartment  of  the  consumptive  ought  always  to 
be  selected  in  a  warm  and  sheltered  situation,  with 
a  southern  aspect ;  and  the  floor  should  be  carpeted, 
.  and  fuel  procured,  and  cold  weather  provided  for, 


OF    CONSUMPTION.  215 

as  at  home.  There  will  probably  be  but  a  few  days 
during  ordinary  winters,  even  in  the  south  of  Italy, 
that  the  invalid  will  not  need  a  little  fire,  at  least 
in  the  morning  and  evening,  to  take  off  the  un- 
pleasant chill  occasioned  by  the  dampness  so  usual 
in  the  houses  there. 

Though  the  pulmonic  symptoms  be  much  allevi- 
ated by  a  winter's  residence  abroad,  still  the 
individual  should  not,  under  the  flattering  belief 
that  his  health  is  confirmed,  return  to  the  climate 
from  whence  he  fled  for  safety,  otherwise  he  may 
learn,  when  the  cold  of  winter  returns,  that  his 
disease  was  but  partially  repressed,  and  perchance 
when  it  is  too  late  to  derive  benefit  from  a  repeti- 
tion of  the  change.  The  truth  is,  one  who  is 
strongly  predisposed  to  consumption,  and  more 
especially  if  he  has  experienced  any  of  its  threaten- 
ing symptoms,  can  never  be  safe,  during  the  cold 
months,  in  the  northern  parts  of  the  United  States. 
If,  therefore,  he  would  avail  himself  of  the  best 
security  for  his  life,  he  must  spend  his  winters  and 
springs,  at  least  for  a  long  course  of  years,  in  less 
rigorous  climes. 

The  hot  months  of  the  year  should  never  be 
passed  in  the  south  of  Europe,  since  intense  and 
long  continued  heat  is  likely  to  be  injurious  to  those 
predisposed  to  consumption,  and  is  almost  sure  to 
accelerate  the  disease  when  it  has  begun  to  develop 
itself  Hence  the  consumptive  traveller  should 
always  so  arrange  his  plans  as  to  advance  south  in 
the  autumn,  and  return  north  in  the  summer.     Dr 


216  TREATMENT 

Clark,  with  his  accustomed  good  sense,  advises 
Lausanne  and  Geneva  as  summer  residences  for  the 
phthisical.  I  conceive,  however,  that  it  will  be 
better,  if  practicable,  to  make  frequent  journeys  from 
place  to  place  during  the  warm  season,  than  to 
continue  long  stationary  in  any  one. 


CHAPTER  XVIII. 

TREATMENT    OF    CONSUMPTION     CONTINUED. 

Climate  of  the  south  of  Europe.  —  What  we  term 
the  south  of  Europe,  comprising  many  degrees  of 
latitude,  different  locations  in  it  must  consequently 
vary  materially  in  their  annual  range  of  temper- 
ature. Other  circumstances,  too,  beside  the  degree 
of  latitude,  as  elevation,  vicinity  to  the  sea,  conti- 
guity to  high  mountains,  and  their  relative  position, 
whether  north  or  south,  will  greatly  influence  the 
temperature,  as  well  as  other  conditions  of  the 
climate  of  particular  situations. 

Many  invalids,  I  apprehend,  visit  the  south  of 
Europe  with  too  exalted  expectations  in  regard  to 
its  climate,  and  finding  it  like  all  others,  imperfect, 
they  become  disappointed,  and  exaggerate  its  faults. 
The  truth  is,  a  winter  cannot  be  escaped  in  Europe ; 
and  he  who,  even  in  its  most  southern  and  favorable 
situations,  fancies  only  bright  skies  and  balmy  airs 
during  winter  and  spring,  will  probably  soon  dis- 


OF    CONSUMPTION.  217 

cover  his  error.  The  tramontana,  or  north  wind  of 
Italy,  passing  over  the  glaciers  of  the  Alps,  and  the 
snowy  tops  of  the  Apennines,  is  particularly  bleak, 
and  e:s:tremely  perilous  to  those  laboring  under 
affections  of  the  lungs,  unless  their  bodies  are  cau- 
tiously defended  against  its  chilling  influence.  The 
great  power,  too,  of  the  sun's  rays  in  the  clear  at- 
mosphere, so  common  in  Italy,  causes  this  wind  to 
be  more  keenl^y  felt  by  the  invalid,  when  it  suddenly 
blows  upon  him.  It  also  alternates  with  the  sirocco, 
or  southeast  wind,  which  comes  from  the  burning 
sands  of  Africa,  relaxing  every  pore  of  the  body, 
and  rendering  it  painfully  susceptible  to  this  pierc- 
ing mountain  blast.  Though  no  part  of  Italy  is 
exempt  from  the  unwelcome  tramontana,  still,  in 
some  of  its  more  southern  portions  —  Rome,  for  ex- 
ample,—  the  Apennines,  which  longitudinally  bisect 
it,  serve  to  break  the  force  of  the  winds,  and  to 
render  the  air  more  tranquil. 

Though  the  tramontana  and  sirocco  are  truly  dis- 
agreeable, yet  I  fancy  that  the  accounts  given  of 
them  by  many  English  writers,  will  appear  to 
Americans — I  mean  those  in  good  health,  —  to  be 
too  highly  colored.  The  truth  probably  is,  that 
the  English  being  less  accustomed  to  great  extremes 
of  temperature  than  ourselves,  feel  them  with  a  more 
acute  sensibility.  In  England,  the  air  being  always 
more  or  less  influenced  in  its  passage  over  the  ocean, 
receiving  or  imparting  caloric,  the  atmospheric 
transitions,  though  sudden,  can  rarely  be  very  great. 
No  cold  blasts  from  glaciers,  and  snow-clad  moun- 
28 


218  TREATMENT 

tains  are  experienced,  and  the  hot  airs  of  the  south 
are  all  tempered  by  the  ocean,  before  arriving  at 
this  healthful  isle. 

Though  I  have  repeatedly  experienced  the  tra- 
montana,  and  in  February,  and  on  elevated  situa- 
tions, yet  I  never  endured  such  painful  effects  from 
it,  as  described  by  Dr  James  Johnson,  in  his  valua- 
ble and  interesting  work  on  change  of  air.  Speak- 
ing of  Genoa,  he  says — "When  I  mounted  the 
higher  light-house,  (Fanale,)  perched  on  a  rocky 
promontory  near  the  commencement  of  the  Mole, 
to  enjoy  the  magnificent  scenery  of  Genoa  and  its 
neighborhood,  the  tramontane  blast  was  so  piercing, 
that,  hardened  as  I  was  against  atmospheric  transi- 
tions, I  was  yet  unable  to  withstand  it  for  more 
than  a  few  minutes  at  a  time,  and  repeatedly  was  I 
obliged  to  retreat  into  the  lantern  to  recover  my 
breath,  and  elude  the  icy  current  of  air  from  the 
mountains !"  And  again —  "  The  tramontane  comes 
down  from  the  Alps  or  Apennines  with  such  a  vo- 
racious appetite  for  caloric,  that  it  sucks  the  vital 
heat  from  every  pore — shrivels  up  the  surface  of 
the  body — impels  the  tide  of  the  circulation,  with 
great  violence,  upon  the  internal  organs,  —  and  en- 
dangers the  lungs,  or  whatever  other  structure 
happens  to  be  weakest  in  the  living  machine."  Of 
the  effects  of  the  sirocco,  too,  he  speaks  in  language 
equally  strong — "Yesterday  the  Sirocco — 'Aus- 
ter's  sultry  breath,'  —  steamed  over  Naples,  depres- 
sing the  animal  spirits  and  the  vital  energies  to  the 
lowest  ebb.     It  is  impossible  to  convey  in  words 


OF   CONSUMPTION.  219 

any  adequate  idea  of  the  sedative  effects  of  this 
wind  on  mind  as  well  as  body.  I  tried  to  respire 
in  freedom  on  the  roof  of  the  Vittoria,  —  on  the  Chi- 
aja,  —  the  Mole,  —  the  Chiatomone ;  but  found  no 
relief  from  the  nervous  depression  and  muscular 
languor  induced  by  this  mephitic  composition  of 
rarefied  air  and  aqueous  exhalation.  I  hired  a  ca- 
lessino  and  drove  round  the  promontory  of  Posilipo 
—  and  afterwards  ascending  to  the  airy  castle  of  St 
Elmo,  wandered  through  the  beautiful  church  of 
St  Martino — but  all  in  vain  !  From  lassitude  of 
body  and  dejection  of  mind  there  was  no  escape, 
while  this  accursed  blast  prevailed." 

It  is  for  like -reasons,  too,  that  our  anticipations 
of  the  richness  and  beauty  of  the  skies  of  Italy  — 
being  founded  on  the  high-wrought  descriptions  of 
the  English,  who  take  their  own  as  the  standard  of 
comparison, — are  seldom  fully  realized. 

From  the  geographical  position  of  Italy,  the 
range  of  atmospheric  vicissitudes  are  greater  than 
in  England,  but  happen  at  longer  intervals.  In  the 
northern  portion  of  our  own  country,  however, 
these  transitions,  at  the  same  time  that  they  are 
more  frequent,  are  also  to  a  much  more  considera- 
ble extent  than  in  any  part  of  the  south  of  Europe. 

In  the  southern  portions  of  Europe,  the  winters 
are  relatively  short,  and  long  continued  periods  of 
pleasant  weather  are  often  experienced  during  them, 
when  the  inestimable  advantage  of  exercise  in  the 
open  air  may  be  daily  enjoyed.  The  springs,  how- 
eve^r,  are  often  cool  and  unpleasant,  and  hence  Dr 


220  TREATMENT 

Clark  regards  it  as  a  more  difficult  matter  to  find  a 
proper  residence  for  spring  than  for  winter. 

Taking  all  circumstances,  then,  into  considera- 
tion, and  making  due  allowance  for  evils  which 
must  be  encountered,  I  am  inclined  to  think,  that 
with  proper  care  and  forethought,  the  consumptive 
invalid  may  winter  pretty  comfortably  in  some  judi- 
ciously chosen  spot  in  the  south  of  Italy.  That 
there  are,  as  previously  stated,  locations  on  the  face 
of  the  earth  far  preferable  in  regard  to  climate, 
cannot  be  questioned ;  but  then,  beside  being  ob- 
noxious to  numerous  inconveniences,  they  present 
but  few  inducements,  either  of  pleasure  or  instruc- 
tion. An  invalid  might  be  readily  persuaded  to 
sojourn  in  the  south  of  Europe,  where  all  the  com- 
forts of  life,  and  the  most  refined  enjoyments  both 
of  sense  and  intellect,  would  be  anticipated,  though 
he  might  be  very  loath  to  abandon  his  home  for  a 
small  and  solitary  island,  or  some  half  civilized  spot 
in  South  America. 

I  will  now  briefly  remark  on  the  character  of  a 
few  different  locations  in  the  south  of  Europe,  as 
winter  residences  for  the  consumptive.  I  shall  re- 
strict my  observations  to  the  larger  towns  and  cities, 
as  the  inferior  ones,  and  villages — particularly  of 
Italy,  —  are  usually  dirty  ;  their  population  poor 
and  squalid,  and  they  are  often  wanting  even  in  the 
ordinary  comforts  of  life.  It  is,  then,  in  the  great 
towns,  only,  in  southern  Europe,  that  the  invalid 
can  feel  secure  of  such  accommodations  and  atten- 
tions, as  may  be  needful  to  him. 


OF    CONSUMPTION.  221 

South  of  France.  —  Several  towns  in  the  south  of 
France,  as  Marseilles,  Montpellier,  Hyeres,  &c., 
were  formerly  more  or  less  resorted  to  by  those 
afflicted  with  pulmonic  complaints.  They  are  liable, 
however,  to  cold  dry  winds  from  the  north  and 
northwest  —  the  latter  termed  the  mistral,  —  and 
affections  of  the  lungs  are  quite  common,  and  in 
some  of  them,  as  Marseilles,  for  example,  are  apt 
to  be  very  acute.  Hyeres,  being  in  a  measure 
sheltered  from  the  north  and  northwest  winds  by  a 
range  of  hills,  the  climate  is  milder,  and  pulmonic 
diseases  "are  said  to  be  less  prevalent,  than  in  most 
other  places  in  this  portion  of  Europe.  It  is  a  place 
of  much  resor-t  for  French  valetudinarians.  Still  it 
is  not  exempt  from  the  influence  of  the  north  winds, 
and  as  a  winter  residence,  it  is  quite  too  cold  for 
the  consumptive.  In  truth,  one  who  has  crossed 
the  wide  Atlantic  in  search  of  a  more  favorable 
clime,  should  not  be  satisfied  to  rest  any  where  in 
the  south  of  France. 

Nice  in  Piedmont.  —  This  town,  in  43'  42'  north 
latitude,  is  situated  in  a  small  plain,  bounded  on  the 
south  by  the  Mediterranean,  on  the  north  by  the 
Maritime  Alps,  and  on  the  west  by  the  river  Var. 
The  superior  mildness  of  its  climate,  depends  mainly 
on  the  lofty  mountain  barrier,  which  partly  shelters 
it  from  the  northern  blasts.  The  thermometer  du- 
ring the  coldest  months,  seldom  falls,  save  at  night, 
to  the  freezing  point ;  the  mean  temperature  of 
winter,  is  about  48  of  Fahrenheit's  scale,  and  the 
daily  range  is  probably  as  small  as  at  most  other 


222  TRKATMENT 

places  on  the  continent.  The  atmosphere  is  gener- 
ally clear,  and  somewhat  dry.  It  is  exposed,  how- 
ever, to  the  chilling  northeast  and  east  winds,  which 
are  very  frequent  during  spring. 

Nice  is  quite  a  resort  for  English  invalids,  and 
has  enjoyed  no  small  share  of  fame,  as  a  residence 
in  the  disease  under  consideration.  Still,  careful 
inquiry  has  found  its  atmosphere  to  be  too  dry  and 
exciting  for  most  pulmonic  complaints,  and  the  cold 
Avinds  alluded  to  as  prevailing  in  the  spring,  render 
it  decidedly  unsafe  at  this  season. 

Genoa  in  Sardinia.  —  In  latitude  44  24'  north. 
The  city,  in  the  form  of  an  amphitheatre,  at  the 
head  of  the  gulf  of  its  name,  is  seen  rising  high  up 
on  the  precipitous  and  craggy  sides  of  the  Apen- 
nine,  whose  lofty  ridges  seem  to  overhang  every 
part  of  it,  save  that  toward  the  sea,  and  this  is  shut 
in  by  high  walls,  and  thus  in  part  protected  from 
the  bleak  winds  coming  from  the  Mediterranean. 
The  Apennines  sweep  round  the  harbor  in  a  semi- 
circular form,  and  terminate  in  two  capes  inclining 
toward  each  other. 

With  a  few  exceptions,  lanes  or  wyndes,  no  more 
than  eight  or  ten  feet  broad,  are  alone  seen  in  this 
singular  city ;  and  as  the  houses  rise  on  each  side 
of  them  to  the  height  of  from  six  to  nine  stories, 
they«seem  like  deep  and  narrow  trenches  or  fissures, 
where  the  sunbeams  never  enter,  and  from  whose 
depths,  the  cheerful  heavens  are  hardly  seen  ;  and, 
as  the  din  of  carriages  is  never  heard  in  them,  they 
are  characterised  by  a  stillness  at  once  striking  and 
solemn. 


OF    CONSUMPTION.  223 

Owing  to  the  geographical  position-  of  Genoa,  its 
climate  is  cold  and  variable  during  winter  and  spring, 
and  the  winds  which  come  from  the  mountains  are 
chill  and  piercing.  Still,  the  invalid  who  could  con- 
tent himself  to  dwell  amid  the  gloom  of  one  of  its 
narrow  passages,  in  a  low  and  sheltered  situation, 
might  feel  secure  against  the  dangerous  tramontana, 
and  enjoy  a  quite  equable  temperature.  Here  he 
might  pursue  his  exercise  in  cool  weather,  but  when 
the  airs  came  soft  and  gentle  from  the  Mediterra- 
nean, then  he  could  resort  to  some  more  open  space 
—  to  one  of  its  wide  and  beautiful  streets,*  or  to  the 
broad  and  extensive  rampart,  which,  being  open  to 
the  sea  and  sun,  forms  so  delightful  a  promenade  in 
the  mild  days  of  winter.  From  circumstances 
growing  out  of  the  peculiar  construction  and  situa- 
tion of  this  city,  Dr  James  Johnson  is  inclined  to 
think  highly  of  it  as  a  winter  residence  for  the  con- 
sumptive. 

The  little  time  I  passed  in  Genoa,  was  in  the 
month  of  February ;  the  weather  was  then  unusu- 
ally mild  —  no  outside  garment  being  at  any  time 
required,  —  and  the  sky  was  remarkably  clear  and 
beautiful. 

As  only  a  few  streets  are  passable  for  carriages, 
walking  is  the  exercise  that  must  be  mainly  trusted 
to  by  the  invalid.  The  common  method  of  convey- 
ance here,  for  those  unable  or  unwilling  to  walk,  is 

"There  are  but  three  principal  streets  in  Genoa  ;  Strada  Balbi,  Strada 
Nuova,  or  street  of  palaces,  and  Strada  Nuovissiina.  These  are  wide 
clean,  iiandsotneiy  paved,  and  truly  magnificent. 


224  TREATMENT 

the  sedan  chair.  Many  of  the  streets  are  so  steep 
—  steps  being  often  required  to  mount  from  one  to 
another,  —  that  the  consumptive  cannot  ascend 
them  without  endangering  more  or  less  embarrass- 
ment of  respiration,  such  ought,  therefore,  to  be 
avoided,  and  the  more  level  ones  selected  for  the 
purpose  of  exercise. 

Genoa  certainly  appears  to  be  a  very  agreeable 
place  of  residence.  Its  population  is  about  eighty- 
five  thousand.  It  abounds  in  sumptuous  marble 
palaces,  enriched  with  choice  paintings,  and  other 
works  of  art  ;  in  handsome  churches,  and  other 
public  buildings  of  high  interest.  Its  new  theatre, 
is  also  particularly  spacious  and  magnificent.  Nu- 
merous gardens,  elevated  on  terraces,  adorn  the 
city,  and  the  neighboring  country,  in  some  direc- 
tions, is  romantic  and  beautiful.  Many  of  the 
southern  fruits  abound  here,  as  the  citron,  orange, 
fig  ;  and  extending  high  up  on  the  mountain-sides, 
is  seen  the  ever  verdant  olive. 

The  hotels  in  Genoa  are  commodious,  and  furnish 
all  requisite  comforts  at  a  cheap  rate. 

Though,  however,  the  consumptive  invalid  might 
probably,  in  the  way  mentioned,  pass  a  winter  and 
spring  in  this  city,  with  safety,  still,  if  no  special 
circumstances  contravene,  I  would  certainly  advise 
him  to  continue  on  his  journey  yet  further  south. 

Pisa  in  Tuscany.  —  The  latitude  of  this  city  is 
43  43'  north.  It  stands  low,  being  situated  in  an 
extensive  alluvial  plain,  stretching  from  the  base  of 
the  Apennines  to  the  Mediterranean  at  Leghorn. 


OF    CONSUMPTION. 


225 


The  Apennines  sweep  partly  round  it,  though  at 
some  dis^tance,  affording  beautiful  mountain  scenery, 
and  a  partial  shelter  against  the  bleak  north  winds. 

Pisa  contains  about  eighteen  thousand  inhabitants; 
it  is  enclosed  by  high  walls,  and  divided  into  two 
nearly  equal  parts  by  the  Arno,  which  curves  grace- 
fully through  it.  The  streets  are,  for  the  most  part, 
wide,  and  straight;  handsomely  paved  with  large 
flat  stones,  and  tolerably  clean. 

Silence  and  inactivity  are  the  striking  character- 
istics of  this  city,  and  its  lonely  streets  and  scat- 
tered population  afford  but  feeble  memorials  of  its 
former  grandeur,  when  it  was  the  capital  of  a  great 
and  warlike  republic,  and  a  hundred  and  fifty  thou- 
sand inhabitants  dwelt  within  its  walls. 

Its  two  most  beautiful  streets  are  the  Lung'  Arno. 
These  are  broad,  quiet  and  clean  ;  extending  along 
the  curved  and  handsome  quays,  on  one  side  bound- 
ed by  the  river,  and  guarded  by  a  wall  breast-high, 
and  on  the  other,  lined  by  fine  ranges  of  lofty  build- 
ings. These  streets  —  free  from  the  bustle  and 
noise  of  a  more  busy  and  thriving  city,  —  afford 
pleasant  promenades  for  the  invalid.  Much  of  the 
scenery  about  Pisa,  is  soft  and  varied,  and  without 
its  walls,  are  many  agreeable  walks  and  rides  which 
may  be  enjoyed  in  fine  weather. 

Pisa  being  situated  in  a  low  vale,  on  the  banks  of 
a  river,  but  a  few  miles  distant  from  the  sea,  and 
sheltered,  in  a  degree,  on  the  north,  by  mountains, 
possesses  a  somewhat  still,  moist,  and,  for  the  most 
part,  a  rather  mild  atmosphere.  Its  climate  much 
29 


226  tkeatmi:nt 

resembles  that  of  Rome,  being,  however,  a  little 
cooler,  and  something  more  moist ;  and  north  of 
Rome,  there  is  probably  no  town  in  Italy  superior 
to  it  for  the  consumptive.  It  also  forms  a  particu- 
larly tranquil  residence  for  tliose  desirous  of  retire- 
ment. In  February  I  found  the  air  quite  soft 
during  the  day,  though  a  little  frosty  at  night. 

In  Dr  Clark's  work  on  the  climate  of  Italy,  &c. 
we  find  the  mean  results  of  the  temperature  of  Pisa 
for  the  six  winter  months  of  three  years,  (1814,  '15, 
'16,)  taken  from  the  observations  of  Professor  Zan- 
nini,  made  at  sunrise,  2  P.  M.,  and  sunset.  The 
mean  temperature  of  January,  was  44  08 ;  max- 
imum of  absolute  temperature  60  06,  minimum  22' 
55.  February — Mean  47  79;  max.  58  55;  min. 
20  75.  March— Mean  52  77;  max.  66  88; 
min.  34' 7.  October— Mean  63  23;  max.  77; 
min.  47  79.  November — Mean  52  99  ;  max.  66^ 
43;  min.  33  15.  December  — Mean  45'  91; 
max.  57  65  ;  min.  22  77.  Fahrenheit's  thermom- 
eter was  employed.  The  most  prevalent  winds 
were  from  the  northeast. 

Though  Pisa,  however,  probably  offers  as  many 
advantages  in  pulmonic  difficulties  as  any  other 
town  in  the  south  of  Europe  north  of  Rome,  still 
its  climate  is  somewhat  variable,  and  the  unwel- 
come tramontana  will  at  times  intrude  itself  even 
into  the  most  sheltered  spots.  High  winds,  too, 
especially  in  the  spring  and  autumn,  are  also  oc- 
casionally experienced ;  and  in  the  former  season, 
are  oftentimes  quite  sharp. 


OF    CONSLIMPTION.  227 

The  invalid,  on  arriving  at  Pisa,  should  be  par- 
ticular to  select  his  lodgings  on  the  Lung'  Arno,  on 
the  northern  bank  of  the  river,  which  being  more 
immediately  sheltered  from  the  tramontana,  and 
exposed  all  day  to  the  sun's  rays,  enjoys  an  obvi- 
ously milder  temperature  than  the  Lung'  Arno  on 
the  opposite  side.  It  also  forms  a  v^^arm  and  pleas- 
ant winter  promenade.  The  consumptive,  however, 
should  be  well  apprized,  that  the  very  fact  of  its 
relatively  high  temperature  enhances  the  danger  of 
a  sudden  transition  from  it,  in  cool  weather,  to  more 
unsheltered  situations. 

Pisa  is  a  considerable  resort  for  the  English  du- 
ring the  winter  season,  and  there  are  many  objects 
here  to  interest  the  stranger.  Living  is  likewise 
cheap,  and  the  hotels  and  lodging  houses  are  very 
comfortable. 

Leghorn  in  Tuscany.  —  This  city  is  about  fourteen 
miles  south  of  Pisa.  It  is  a  noisy,  bustling,  dirty 
place,  overrun  with  loathsome  beggars  —  compris- 
ing sixty  thousand  inhabitants  within  the  circuit  of 
two  miles,  and,  being  a  free  port,  the  motley  crowds 
from  all  parts  of  the  earth  are  seen  congregated  in 
it.  Having  sprung  up  in  modern  times,  it  presents 
but  few  objects  of  interest  to  the  traveller.  It  is 
much  exposed  to  strong  winds,  and  all  things  con- 
sidered, is  quite  unsuitable  for  those  suffering  from 
pulmonic  complaints. 

Florence  in  Tuscany.  —  Situated  in  latitude  43  46' 
north,  in  the  luxuriant  and  romantic  Val  d'Arno 
Florence  is  truly  a  delightful  city.     Its  streets  are 


228  TREATMENT 

broad,  comparatively  clean,  and  handsomely  paved ; 
its  buildings  fine ;  its  society  good ;  all  the  comforts 
of  life  are  readily  obtained  in  it,  and  at  a  trifling  ex- 
pense, and  it  abounds  in  every  thing  to  interest  and 
instruct  the  visitor  of  taste  and  cultivated  intellect. 
Still,  in  favor  of  its  climate  for  the  consumptive  in- 
valid, but  little  can  be  said.  It  being  exposed  to 
the  bleak  tramontana,  and  the  burning  sirocco,  it  is 
liable  to  be  very  cold  in  winter,  and  hot  during 
summer.  So  cold  is  it  during  some  winters,  that 
the  Arno  becomes  frozen,  and  even  the  northern 
amusement  of  skating  has  been  witnessed  upon  it. 
The  air  is  commonly  quite  dry,  the  skies  clear  and 
brilliant,  and  the  winds  often  high;  and  when  they 
blow  cold  from  the  mountains,  remind  us,  in  some 
faint  degree,  of  our  own  winter  northwest  blasts. 

I  passed  a  short  period  in  Florence  in  Februar}^ 
The  skies  were  clear,  the  air  was  quite  dry,  the 
north  wind  for  the  most  part  blew  cold,  rushing 
through  the  streets,  sweeping  round  their  corners, 
and  often  incommoding  one  with  clouds  of  dust.  I 
again  visited  it  in  the  early  part  of  May,  and  then 
experienced  considerable  rainy  weather,  and  fre- 
quent high  and  cool  winds,  and  became  affected  in 
consequence  with  a  pulmonary  catarrh.  Pulmonary 
complaints  are,  in  truth,  quite  common  here  during 
winter  and  spring.  A  fire,  in  the  morning  and  eve- 
ning, will  not  unusually  be  required  by  the  sensi- 
tive invalid,  even  in  the  month  of  May. 

The  consumptive  subject  may,  doubtless,  tarry 
here  with  safety,  for  a  little  time,  in  the  middle  of 


OF    CONSUMPTION.  229 

autumn,  or  at  the  close  of  May  and  fore  part  of 
June ;  but  at  other  periods  there  is  danger  that  the 
weather  will  be  either  too  hot  or  too  cold  for  his 
safety.  The  dryness  of  the  air  also  forms  an  objec- 
tion to  it  as  a  residence  for  persons  of  a  consumptive 
habit. 

If  the  individual  laboring  under  pulmonic  com- 
plaints happens  unfortunately  to  be  in  Florence 
during  the  cool  seasons,  he  should  procure  a 
residence  on  the  Lung'  Arno,  on  the  north  side  of 
the.  river,  this  being  exposed  to  the  sun's  rays,  and 
sheltered  by  the  city  from  the  tramontana. 

The  principal  drive  and  promenade  of  the  Flor- 
entines, is  the  Cascini  or  cow  pasture.  These 
grounds  include  the  farm  and  farm  house  or  lodge 
of  the  Grand  Duke.  They  are  pleasant,  handsomely 
ornamented  with  forest  trees,  extend  several  miles 
along  the  right  bank  of  the  Arno,  and  are  always 
open  to  the  public.  In  the  warm  months,  they 
form  an  agreeable  place  for  exercise,  either  walking 
or  riding,  but  are  bleak  and  exposed,  and  conse- 
quently to  be  avoided  by  the  invalid  during  the  cold 
seasons. 

Rome.  —  The  location  of  this  city  is  in  the  Cam- 
pagna  di  Roma,  in  latitude  41  54'  north.  Were 
we  to  found  our  judgment  of  the  climate  of  Rome 
on  the  evidence  of  its  ancient  historians  and  poets, 
it  would  be  any  thing  rather  than  favorable.  But 
a  material  change  must  have  taken  place  in  it  in 
modern  days,  for  the  streets  of  this  city  are  now 


230  TREATMENT 

very  rarely  whitened  by  snow,  and  tlie  current  of 
the  Tiber  is  no  longer  seen  obstructed  with  ice. 

The  atmosphere  of  Rome  is  moderately  moist, 
and  more  serene  than  that  of  most  other  cities  in 
Italy.  This,  at  least,  is  true  of  that  portion  of  it 
which,  being  built  on  the  ancient  Campus  Martius, 
lies  low  and  sheltered  by  the  surrounding  hills.  A 
good  deal  of  clear  and  pleasant  weather  is  also  ex- 
perienced both  during  w^inter  and  spring,  when  the 
consumptive  may  be  abroad  with  safety.  Still  let 
not  the  invalid  flatter  himself  that  even  here  the  air 
wull  be  uniformly  mild.  The  tramontana  from  the 
snow  clad  Apennines  will  at  times  find  its  way  into 
the  most  sheltered  parts  of  the  city ;  and  though 
perhaps  less  severe  than  in  most  other  towns  in 
Italy,  yet  is,  for  the  most  part,  extremely  uncom- 
fortable. The  atmosphere  is  occasionally  quite 
cool  in  Rome,  even  in  April  and  the  early  part  of 
May,  so  that  great  coats,  in  the  morning  and  even- 
ing at  least,  may  be  required  on  going  abroad, 
and  fires  become  absolutely  essential  to  the  comfort 
of  the  invalid.  To  be  sure,  such  weather  is  but 
little  regarded,  and  perchance  hardly  remembered 
by  the  healthy  traveller,  glowing  with  excitement 
from  exercise,  and  the  intensely  interesting  objects 
around  him ;  but  far  otherwise  will  be  the  case  with 
the  feeble  and  delicate,  who  are  abroad  in  search 
of  health. 

The  visits  I  paid  to  Rome  were  in  the  months  of 
February  and  April,  and  were,  of  course,  of  inad- 
equate duration  to  warrant  any  general  conclusion 


OF    CONSUMPTION.  231 

in  relation  to  its  climate  from  them  alone.  My 
short  sojourn  in  February  impressed  me  very  favor- 
ably in  regard  to  it  as  a  mild  winter  residence. 
The  atmosphere  was  mostly  still,  and  though  the 
mornings  were  somewhat  cool,  yet  the  sun,  when 
sufficiently  elevated,  was  pleasantly  warm,  and  the 
consumptive  might  have  been  abroad  in  the  open 
air  with  safety  and  comfort.  In  April — most  of 
which  month  I  spent  in  this  city,  —  though  on  many 
days  the  sky  was  clear,  and  the  air  serene  and 
balmy,  yet  I  experienced  more  uncomfortable 
weather  than  I  had  anticipated  at  this  season. 
There  were  a  number  of  rainy  days,  cool  and  high 
winds  were  not  unfrequent,  and  in  the  morning  and 
evening  outside  garments  were  often  needed  even 
by  those  in  health,  and  fires  certainly  by  the  invalid. 
On  the  hills  and  in  the  forum  I  was  often  incommoded 
by  strong  winds,  and  in  the  latter  situation,  espe- 
cially, from  the  quantity  of  dust  raised  by  them.  I 
learnt,  however,  that  this  month  was  more  unpleas- 
ant than  ordinarily  happens.  It  must  of  course  be 
expected  that  different  seasons  will  vary  more  or 
less  in  their  mildness  or  severity;  still,  to  be  duly 
guarded  against  them,  one  should  be  apprized  of 
the  most  unfavorable  conditions  of  a  climate  that 
may  occur. 

Dr  Clark  has  given  us  a  table  of  the  mean  results 
of  the  temperature  of  Rome  of  three  years,  (1815, 
'16,  '17,)  for  the  six  winter  months,  from  observa- 
tions by  Professor  Conti,  of  the  Collegio  Romano. 
The  observations  were  taken  at  7  A.  M.,  2  P.  M., 


232 


TREATMENT 


and  9  P.  M.  According  to  this,  the  mean  temper- 
ature of  October  was  61'  32;  maximum  of  absolute 
temperature,  76  78;  minimum,  43'  92.  Novem- 
ber, mean,  53  5;  max.  69  12 ;  min.  33'  8.  De- 
cember, mean,  46  22;  max.  62  12 ;  min.  29'  52. 
January,  mean,  45  16;  max.  59  45  ;  min.  27' 72. 
February,  mean,  48  53 ;  max.  64  62  ;  min.  27  5 ; 
March,  mean,  52°  18;  max.  66°  65;  min.  35°  15. 
The  prevailing  wind  during  winter  is  from  the 
north. 

The  mean  annual  temperature  of  Rome  is  about 
60°  of  Fahrenheit's  scale. 

Rome  is  regarded  by  Dr  Clark  as  a  preferable 
situation,  for  the  generality  of  consumptive  subjects, 
to  those  more  commonly  advised;  and  he  considers 
it  as  affording  especial  advantages  during  spring — 
being  then  less  liable  to  keen  and  cutting  winds  than 
most  other  places  which  he  had  visited.  He  also 
adduces  some  cases  in  corroboration  of  the  favorable 
influence  of  its  climate.  The  result  of  my  own 
limited  observations  and  inquiries,  certainly  goes 
to  sustain  the  accuracy  of  Dr  Clark's  opinion;  and 
taking  all  things  into  account,  I  am  disposed  to 
think  that  the  majority  of  those  laboring  under  pul- 
monic affections,  will  be  as  well  satisfied  in  Rome, 
and,  with  due  forecast,  may  pass  the  winter  and 
spring  there  as  comfortably,  and  be  subjected  to  as 
limited  atmospheric  vicissitudes,  as  probably  in  any 
other  city  in  the  south  of  Europe. 

Here,  however,  as  in  all  other  places,  many  pre- 
cautions are  necessary  on  the  part  of  the  invalid. 


OF    CONSUMPTION.  233 

In  cool  and  windy  weather,  the  hills,  the  forum,  and 
other  exposed  parts  of  the  ancient  city  should  be 
avoided,  and  exercise  be  taken  in  the  lower  and 
more  sheltered  situations  on  the  Campus  Martins ; 
even  here,  however,  many  of  the  streets  being  nar- 
row and  deprived  of  the  genial  influence  of  the  sun's 
rays,  are  often  damp  and  chilly.  The  museums  are 
apt  to  be  cool,  and  not  unfrequently  damp,  and  it  is 
unsafe  to  tarry  long  in  them.  The  same  may  also 
be  said  of  the  ruins  —  at  least  of  the  subterranean 
ones,  —  of  the  old  city;  and  hence  when  visited, 
extra  clothing  should  be  worn,  and  the  stay  among 
them  be  short.  The  customary  visit  to  the  Colos- 
seum by  moonlight,  cannot  be  made  without  hazard 
by  those  suffering  under  pulmonic  complaints.  Of 
the  danger  of  visiting  the  churches  of  Italy,  I  have 
already  warned  the  invalid. 

The  consumptive  subject  should  never  go  abroad. 
Unless  the  weather  be  unusually  mild,  until  the  sun 
has  risen  so  high  as  to  impart  its  grateful  warmth 
to  the  body ;  and  should  return  to  his  lodgings  be- 
fore it  has  sunk  below  the  horizon.  Evening  visits 
will  always  be  hazardous  to  the  susceptible  invalid, 
since  the  houses  of  Rome  are  open,  and  often  damp , 
and  the  entries  and  staircases  being  generally  spa- 
cious, are  subject  to  disagreeable  currents  of  air. 
The  floors,  too,  being  of  tile  or  marble,  and  rarely 
carpeted,  are  apt  to  communicate  an  unpleasant 
chill  to  the  feet. 

A  peculiarity  about  Rome,  of  no  small  advantage 
to  the  invalid  anxious  for  tranquillity,  and  in  whom 
30 


234  'I  i(l;a  r.MKNi" 

the  avoidance  oi  all  slroiig  excitements  is  desirable, 
is,  that  though  abounding  in  every  thing  calculated 
to  awaken  interest  and  impart  instruction,  yet,  in- 
stead of  exciting,  its  general  effect  is  to  beget  a 
calmness  and  even  solemnity  of  feeling,  which  may 
tend  indirectly  to  allay  physical  action.  Such  is  the 
influence  of  its  natural  scenery,  its  climate,  the  still- 
ness within  its  walls.  We  feel  it  amid  the  silence 
and  solitude  of  its  forum ;  and  when  contemplating 
the  soft  beauty  and  melancholy  grandeur  of  its  ruins. 
A  quiet  and  solemn  majesty  appears  to  characterize 
almost  every  thing  in  this  remarkable  city.  Its  very 
beggars  often  display  a  gravity  and  stateliness  really 
ludicrous,  and  quite  peculiar  to  the  haughty  de- 
scendants of  ancient  Rome.* 

Some  few  of  the  streets  of  Rome  are  broad  and 
well  paved,  tolerably  neat  and  handsome,  and  many 
of  the  public  rides  and  promenades  about  the  city  are 
very  pleasant.  Various  interesting  excursions,  too, 
wdien  the  weather  permits,  may  be  made  by  the  invalid 
to  neighboring  towns  and  villas.  The  water  is 
remarkably  good  here,  milk  abundant,  and,  in  short, 
all  the  necessaries  and  comforts  of  life  are  easily  and 
cheaply  procured.  The  pleasantest  lodgings  are 
in  the  Piazza  di  Spagna,  or  somewhere  in  its  imme- 
diate vicinity. 

Consumption,  though  not  unfrequent  at  Rome, 
yet  is  less  common  than  in  many  other  cities  in  the 

*  "  Thnre  is,'"  sajs  Dr  Jolinsqji,  "  a  sedative  principle  in  the  air  of  the 
Campagna,  which,  with  tlic  stillness  of  tlie  atmosphere,  and  the  bilence  of 
the  streets  of  Home,  tends  to  trantjuillize,  perhaps  benumb  the  feelings, 
and  lulls  to  repose." — On  (Jhungt  uf  Jlir,  8fc. 


OF    CONSUMPTION.  235 

south  of  Europe.     Its  course  here  is  remarked  to 
be  somewhat  chronic. 

Naples — In  latitude  40  50'  north.  Its  position 
much  resembles  that  of  Genoa.  It  is  partly  built 
on  the  steep  and  craggy  declivity  of  a  range  of  tufa 
hills,  which  rise  abruptly  from,  and  seem  to  crown 
its  beautiful  and  picturesque  bay.  Its  eastern  part, 
however,  extends  over  more  level  ground. 

Though  the  winters  in  this  city  are  something 
warmer  than  at  Rome,  and  the  average  annual  tem- 
perature a  little  higher,  still,  owing  to  its  elevated 
position  and  exposure  to  the  almost  unobstructed 
winds  from  the  Mediterranean,  Naples  is  subject  to 
greater  and  more  frequent  atmospheric  transitions 
than  Rome.  Many,  however,  have  represented  its 
climate  as  the  finest  in  Europe,  and  perhaps  this 
may  be  true  so  far  as  concerns  those  in  health. 
There  are  times  when  the  weather  is  indeed  charm- 
ing. When  the  air  breathes  upon  us  so  balmy  and 
voluptuous,  that,  with  the  exuberance  of  vegetation 
and  the  grand  and  beautiful  scenery  which  nature 
has  here  lavished  with  such  prodigality,  we  can 
actually  fancy  ourselves  in  the  Campagna  Felice,  or 
the  Elysium  of  the  poets.  When  even  the  queru- 
lous invalid  might  cease  to  complain,  and  imagine 
that  his  ends  were  accomplished — that  a  harbor  of 
safety  was  at  length  found.  But  the  gentle  zephyr 
may  soon  give  place  to  the  rude  mountain  blast,  be- 
fore whose  chilling  breath  speedily  vanish  all  our 
pleasing  illusions  of  an  elysian  climate  on  earth. 

Naples  is  more   obnoxious  to  high  winds  than 


236  TREATMENT 

Rome.  Those,  too,  coming  from  the  sea,  are,  at 
certain  seasons,  often  quite  keen  and  chilling.  Its 
skies  are  for  the  most  part  bright,  and  its  climate  is 
generally  viewed  as  more  exciting  than  that  either 
of  Pisa  or  Rome.  In  the  early  part  of  spring,  it  is 
also  particularly  liable  to  piercing  winds,  which  not 
unfrequently  occasion  inflammations  of  the  chest,  and 
are  especially  pernicious  to  those  already  affected 
with  pulmonic  complaints.  Consumption,  too,  is  by 
no  means  an  unfrequent  malady  here.  In  short,  I 
think  the  mass  of  evidence  goes  to  show  that  the 
climate  of  Naples  does  not  generally  agree  so  well 
with  consumptive  invalids — more  certainly  if  they 
have  much  inflammatory  tendency,  —  as  that  of 
Rome. 

I  tarried  a  little  while  in  Naples  near  the  close  of 
February ;  the  weather  was  in  general  mild,  though 
occasionally  the  wind  blew  strong  and  cool  from  the 
mountains  or  the  sea.  The  sky  was  usually  clear 
and  brilliant.  A  fire,  however,  was  uniformly 
needed  in  the  apartment  of  the  invalid  in  the  morn- 
ing and  evening.  In  the  early  part  of  April,  I  found 
the  atmosphere  commonly  mild  during  the  day,  but 
the  evenings  and  mornings  were  oftentimes  chilly. 
The  wind  was  occasionally  high  and  somewhat 
sharp,  and  the  dust  of  the  streets  was  at  times  not 
a  little  annoying.  The  sun's  rays  were  very  pow- 
erful ;  hence,  even  when  the  bleak  tramontana  blew, 
the  heat,  in  situations  sheltered  from  it,  and  exposed 
to  the  sun,  was  always  great.  A  few  severe  showers 
were  experienced,  but  generally  the  sky  was  cloud- 


OF   CONSUMPTIOX.  237 

less.  There  were,  indeed,  but  few  days  during 
either  of  my  visits,  at  some  period  of  which  the  in- 
valid could  not  with  safety  have  enjoyed  exercise  in 
the  open  air. 

As  Rome  is  characterized  by  its  tranquillity  and 
solemn  grandeur,  and  its  consequent  sedative  influ- 
ence on  mind  and  body,  Naples,  on  the  other 
hand,  is  distinguished  for  its  noise,  bustle  and  ex- 
citement. It  is  certainly  the  gayest,  and  by  many 
is  deemed  the  most  captivating  city  of  Italy.  It 
comprises  about  four  hundred  and  fifty  thousand  in- 
habitants, and  as  arts,  traffic  and  amusements  are, 
in  a  great  measure,  conducted  without  doors,  the 
streets  are  always  crowded  and  confused,  and  all 
sorts  of  buffoonery  and  grotesque  sights  are  contin- 
ually witnessed  in  them.  The  Neapolitans  are  as 
volatile  and  lively  as  the  Romans  are  grave  and 
stately.  They  are  passionate,  keen  witted;  and  so 
exuberant  are  their  spirits,  that  misery  itself  cannot 
subdue  them.  Hence  even  their  hungry  and  house- 
less lazzaroni  abound  in  fun  and  antic  tricks — 
exhibiting  the  unnatural  union  of  mirth  with  loath- 
some wretchedness.  Life,  in  this  motley  city,  seems 
indeed  one  continued  comedy. 

Naples,  though  she  lacks  the  stupendous  ruins, 
the  variety  of  sculpture  and  paintings,  and  even  the 
beautiful  modern  architecture  of  Rome,  yet  abounds 
in  objects  of  the  most  intense  interest  and  excite- 
ment. Here  nature  is  seen  in  her  most  gaudy  and 
voluptuous  attire.  The  prolific  soil,  abounding  in 
choice  fruits  and  the  most  beautiful  and  luxm-iant 


238  TREATMENT 

vegetfilion  —  thobay,distin2;uishcdby  its  picturesque 
promontories,  and  its  lofty  and  classic  island  of 
Capri — the  city  rising  above  it  on  the  towering  and 
precipitous  hills,  surmounted  by  its  gloomy  castle 
of  St  Elmo ;  its  smoking  volcano  on  one  side,  and 
its  bright  skies  above,  —  it  seems  as  though  sea,  and 
earth,  and  heaven  were  striving  with  each  other  in 
the  contribution  of  their  beauties  to  the  scene. 
Here,  too,  are  revived  the  pleasing  associations  of  our 
schooldays'  studies ;  for  we  are  in  the  land  of  poetic 
fiction — in  the  country  of  the  Sirens — near  to  the 
Happy  Fields,  Elysium,  and  Tartarus,  and  can  at 
times  almost  realize  the  poet's  dreams  of  heaven 
and  hell.  There  are  probably  few  spots  on  the  face 
of  the  earth,  where  so  many  objects  of  sensual  and 
moral  excitement  are  brought  together  as  in  Naples ; 
and  it  is  for  this  reason,  in  addition  to  the  objections 
urged  against  its  climate,  that  I  view  it  to  be  ordi- 
narily an  unsuitable  residence  in  consumption,  and 
more  especially  so  when  the  disease  manifests  an 
inflammatory  tendency.  There  is,  in  truth,  too 
much  noise  and  confusion  here  for  invalids  gener- 
ally, and  too  much  excitement  is  caught  from  its 
bright  landscapes  and  mercurial  inhabitants.  Few, 
even  in  health,  can  live  amid  its  gayety,  or  urge 
their  way  through  its  beautiful  Toledo,  and  gaze  on 
the  odd  sights  there  exhibited,  without  some  little 
increase  in  the  frequency  of  the  pulse.  The  whole 
moral  world  in  Naples  seems  to  partake  stimulation 
from  its  burning  sun  and  volcanic  fires.  Hence  it 
is  that  invalids,  nay,  even  the  healthy  are  apt  to 


OF    CONSUMPTION.  239 

tire,  to  become  surfeited  with  such  continued  ex- 
citement, and  to  long  for  the  sober  stillness  of 
Rome. 

The  consumptive  invalid  concluding  to  winter  in 
Naples,  should  be  careful  to  obtain  a  warm  and 
sheltered  situation,  for  he  will  discover  a  material 
difference  of  temperature  in  the  different  quarters  of 
the  city.  The  residences  on  the  Chiaja,  Chiatamone 
and  St  Lucia,  though  very  charming  situations  in 
respect  to  natural  scenery,  and  the  fashionable 
abodes  of  strangers,  yet,  being  unprotected  from  the 
sea  winds,  are  too  bleak  during  winter  and  spring 
for  those  with  weak  lungs.  Pleasant  and  pretty 
well  sheltered  .lodgings  may  be  found  in  the  Strada 
Foria,  Largo  del  Castello  and  its  immediate  vicinity, 
and  in  several  other  situations. 

Living  at  Naples  is  cheap  and  good,  and  goats', 
cows'  and  asses'  milk  may  all  be  procured  at  mod- 
erate prices.  The  neighboring  country  abounds  with 
the  most  enchanting  scenery,  and  in  objects  of  the 
most  glowing  interest,  affording  many  very  delight- 
ful excursions.  Let  me,  however,  caution  those 
afflicted  with  pulmonic  complaints  not  to  attempt 
the  ascent  of  Mount  Vesuvius,  unless  in  a  chaise  a 
porteur  (sedan  chair),  since  its  cone  is  quite  steep, 
and  owing  to  its  deep  covering  of  loose  ashes,  very 
hard  to  climb,  and  the  effort  is  apt  to  be  attended 
with  painful  embarrassment  in  the  respiratory  func- 
tion. 


240 


CHAPTER  XIX. 

TREATMENT    OV    CONSUMTTION  CONTINUED.  ISLANDS  OF  SICILY 

AND    MALTA. 

Sicily.  —  Though  there  are  some  situations  in 
Sicily  which  would  afford  a  mild  and  agreeable 
winter  climate,  yet  taking  all  circumstances  into 
account,  this  island  is  by  no  means  a  pleasant  place 
of  abode  for  the  invalid.  The  inhabitants  are  mostly 
poor  and  knavish ;  the  dwellings  are  for  the  greatest 
part  without  fireplaces,  damp  and  uncomfortable ; 
windows  not  always  glazed ;  milk,  certainly  out  of 
the  large  cities,  oftentimes  hard  to  be  procured,  and 
many  situations  scarcely  supply  even  the  needful 
comforts  of  life,  and  the  accommodations  generally 
are  quite  inferior  to  what  they  are  on  the  mainland 
in  Italy.  Travelling,  too,  in  many  parts  of  Sicily, 
can  be  accomplished  only  on  mules,  or  in  a  lettiga* 
and  is  attended  with  inconvej^iences  and  vexations 
which  are  keenly  felt  by  those  in  delicate  health. 
The  locande  or  public  houses  on  the  roads,  are  any 
thing  but  inviting,  pretending  no  more  than  to  fur- 
nish accommodations  for  horses,  and  sleeping  apart- 
ments for  travellers,  and  owing  to  the  usual  vicinity 
or  even  actual  contiguity  of  these  latter  to  the  stable, 
they  are  apt  to  be   infected  with  odors  of  no  very 

*  A  small  carriage  in  very  common  use  in  Sicily,  hung  on  two  strong 
polea,  and  by  means  of  them  supported  on  the  backs  of  mules. 


OF    CONSUMPTION.  241 

agreeable  character.  The  beds,  too,  are  not  un- 
usually dirty  and  damp,  and  when  the  nights  are 
warm,  the  fleas  are  particularly  lively.  None, 
indeed,  but  the  healthy  and  hardened  traveller  may 
anticipate  comfortable  nights  while  journeying  on 
this  island. 

The  winter  temperature,  on  the  coast  and  in  the 
valle3's,  is  something  warmer  than  even  in  the  most 
southern  portions  of  Italy.  Yet  owing  to  the  moun- 
tainous character  of  the  island,  it  is  more  or  less 
exposed,  in  different  situations  and  at  certain  sea- 
sons, to  bleak  winds  and  sudden  atmospheric  vicis- 
situdes. During  the  latter  part  of  February  and 
early  part  of  March,  the  w^eather  is  liable  to  be 
rainy,  cool  and  variable,  and  in  the  more  elevated 
portions,  not  unfrequently  even  tempestuous. 

In  the  beginning  of  spring  I  journeyed  several 
days  over  the  mountainous  parts  of  Sicily.  Much 
of  the  time  the  atmosphere  was  uncomfortably  cold, 
and  strong  wdnds,  with  rain  ar.d  hail  were  frequent. 
The  hill  tops  were  every  where  whitened  with  snow. 
But  to  confn-m  my  statement,  and  at  the  same  time 
to  show  that  mild  airs  and  shining  skies  do  not  alone 
characterize  even  this  luxuriant  and  poetic  isle,  I 
will  take  the  liberty  to  introduce  here  a  few  brief 
extracts  from  my  note  book  in  relation  to  its 
weather. 

Thursday,  March  5th.  — At  1  P.  M.  left  Palermo 
for  Catania.  Day  showery,  windy,  cold  and  alto- 
gether uncomfortable.  Half  past  four,  P.  M.,  moun- 
tains enveloped  in  dense,  black  clouds,  and  raining 
31 


242 


TREATMENT 


and  blowing  severely.  Carriage  closed  as  far  as 
practicable,  and  our  cloaks  are  absolutely  essential 
to  our  comfort.  All  the  Sicilians  we  meet  are  closely 
guarded  by  their  thick  cloaks  and  hoods. 

Friday,  March  6th.  —  Six,  A.  M.  —  Last  night 
rested  at  Villalrati.  No  fireplace  or  chimney  in 
our  wretched  locanda.  Night,  cold  and  rainy,  and 
our  beds  damp.  This  morning,  the  weather  still 
remains  bleak,  with  rain,  hail,  some  snow,  and  a 
high  wind.  Yet  vegetation  is  advanced,  and  the 
fruit  trees  are  in  rich  blossom.  Noon.  —  Raining 
hard,  and  the  air  continues  cold.  Stopped  at  a 
miserable  locanda ;  fled  from  its  desolate,  cold,  damp 
and  foul  rooms  to  the  interior  of  our  coach,  for  com- 
fort. Many  of  the  inhabitants  w^ear  sheep-skin 
trowsers,  the  w^ool  outward,  as  a  defence  against 
the  weather;  and  all  we  see  without  doors  are 
securely  invested  in  their  coarse  cloaks  and  hoods. 
At  half  past  three  in  the  afternoon,  arrived  at  Val- 
lelunga.     Weather  remains  cold  and  blustering. 

Saturday,  March  1th.  —  Recommenced  our  jour- 
ney at  half  past  six  in  the  morning.  Had  been 
raining,  hailing  and  blowing  all  night  long.  Moun- 
tains all  about  us  capped  with  snow.  Ascended  a 
long  and  tedious  hill,  and  on  approaching  its  summit 
found  considerable  snow  in  the  road.  Journeyed 
about  twenty  miles  over  a  broken,  mountainous, 
lonely  and  desolate  country,  to  St  Catarina.  Here 
we  learned,  that  owing  to  the  recent  and  severe  rains, 
the  ford  a  few  miles  in  advance,  had  become  so  high 


OF    CONSUMPTION.  243 

as  to  be  rendered  impassable,  at  least  for  to-day. 
Weather  clear,  though  rather  windy  and  cool. 

Sunday^  March  8ih.  —  Started  on  our  route  at  six, 
A.  M.  Every  night  since  leaving  Palermo  have 
lain  in  damp  beds,  owing  to  the  moist in-e  of  the 
atmosphere  from  the  recent  abundant  rains.  Once 
only  have  Ave  had  the  good  fortune  to  obtain  a  pan 
of  coals  to  temper  a  little  the  air  of  our  lodging 
rooms.  Morning  quite  pleasant,  though  something 
cool.  The  ground  every  where  enamelled  with  the 
gay  and  beautiful  flowers  of  spring.  Forded  with 
some  difficulty  the  mountain  torrent  whose  rise  yes- 
terday delayed  us  on  our  way.  About  half  past 
four,  stopped  for  the  night  at  Leonforte.  Vv'eather 
pretty  pleasant,  though  a  little  cloudy,  yet  still  so 
cool  that  most  of  the  inhabitants  seen  in  the  streets 
have  on  their  cloaks  and  hoods. 

Monday,  March  9th.  —  Were  on  our  way  at  six  in 
the  morning.  The  cold  during  the  night  was  so 
great  as  to  produce  some  thin  ice.  Morning  cool, 
windy  and  cloudy,  and  soon  after  we  had  set  out  it 
rained  hard,  and  some  snow  also  fell.  Our  course 
lay  among  bleak  and  snowy  mountains.  During  the 
forenoon,  the  weather  cleared  up  pleasant,  and  the 
sky  became  very  brilliant.  In  the  afternoon,  there 
was  a  severe  shower,  but  of  short  duration.  To- 
day, passed  high  on  the  side  of  Mount  Etna,  through 
the  town  of  Aderno,  just  beneath  the  region  of  snow, 
and  consequently  experienced  a  considerable  degree 
of  cold.  From  this  bleak  height  we  descended  to 
Paterno,  seated  in  a  charming  valley.     Here,  though 


244  TREATMENT 

Still  high  above  the  sea,  the  air  was  comparatively 
soft,  and  all  the  beauties  of  a  summer's  landscape 
were  suddenly  disclosed  around  us.  Fields  of  grain, 
the  vine,  the  orange,  the  olive  and  fruit  trees  in  full 
blossom  enriched  the  scene,  and  profusions  of 
flowers — 

'■  With  hues  on  hues  expression  cannot  paint," 

embellished  the  earth,  and  exhaled  their  perfumes 
into  the  air.  Above  the  whole  —  its  head  towering 
in  bleak  grandeur,  and  whitening  with  perpetual 
snows,  —  rose  Etna,  in  its  majesty  and  classic  fame. 
Our  quick  transition  from  the  wintry  spot  above, 
served  to  heighten  the  enchantment  of  this  sunny 
vale. 

Tuesday,  March  10th.  —  Descended  to  Catania,  on 
the  shores  of  the  Mediterranean,  at  the  foot  of 
Mount  Etna.  Here  the  weather,  though  cloudy  and 
variable,  was  much  milder  than  I  had  at  any  time 
experienced  it  on  my  journey.  Vegetation  was  as 
far  advanced  as  is  ordinary  in  New  Ens-land  at  the 
end  of  May,  or  beginning  of  June. 

It  will  generally,  I  conceive,  be  unsafe  for  the 
consumptive,  designing  a  tour  through  the  island  of 
Sicily,  to  commence  it  earlier  than  the  last  of  March 
or  fore  part  of  April. 

I  will  now  finish  what  I  have  to  say  in  relation  to 
Sicily  as  an  abode  for  the  phthisical,  with  a  cursory 
notice  of  a  few  of  its  principal  towns.  It  is,  indeed, 
only  in  its  chief  cities  on  the  seacoast,  that  even 
tolerable   accommodations    may  be  expected,    and 


OF    CONSUMPTION.  245 

consequently  it  is  in  such  alone  that  the  invalid 
should  think  of  abiding. 

Palerino.  —  This  city,  in  latitude  38  12'  north,  is 
charmingly  situated  in  the  midst  of  a  rich  and  hand- 
some plain  at  the  base  of  a  crescent,  or  natural 
amphitheatre  of  lofty  and  barren  hills.  The  neigh- 
boring country  is  eminently  picturesque,  and  the 
view  of  the  gulf,  though  inferior  to  that  of  Naples, 
is  exceedingly  beautiful. 

Palermo  contains  about  a  hundred  and  fifty  thou- 
sand inhabitants;  it  has  a  lively  and  interesting 
appearance,  and  is  esteemed  to  be  one  of  the  most 
regular  built  cities  in  Europe.  It  is  ornamented 
with  a  beautiful  quay,  called  the  Marina,  affording 
a  particularly  pleasant  ride  or  walk,  for  the  enjoy- 
ment of  the  sea  air.  The  Upper  Marina  terrace, 
and  adjoining  public  gardens,  are,  in  like  manner, 
very  charming  and  healthful  promenades  for  the 
invalid. 

The  sky  here,  with  the  exception  of  a  short  period 
during  the  last  of  winter  and  beginning  of  spring, 
when  considerable  rain  falls,  is  ordinarilv  unobscured 
and  brilliant,  and  the  sun's  rays  are  at  times  so 
ardent,  as  to  remind  us,  in  no  small  degree,  of  our 
near  approach  to  the  shores  of  Africa.  Owing, 
however,  in  part,  to  the  lofty  hills  in  its  immediate 
vicinity,  Palermo  is  exposed  to  sudden  atmospheric 
vicissitudes,  and  to  occasional  chilling  winds,  during 
winter  and  spring.  The  sirocco,  too,  or  southeast 
blast,  coming  from  the  burning  sands  of  Lybia,  is 
particularly  hot,  oppressive  and  paralyzing  both  to 
the  mental  and  bodily  energies. 


246  TREATMENT 

Palermo,  having  regard  to  climate  alone,  certainly 
enjoys  some  advantages  over  Naples  as  a  winter's 
abode  lor  the  consumptive.  Still,  as  a  place  of  resi- 
dence, it  is  obnoxious  to  many  objections.  The 
streets  are  extremely  crowded,  confused,  noisy — 
many  of  them  dirty,  and  overrun  with  squalid  and 
half  naked  beggars,  whose  piteous  yells,  and  inces- 
sant supplications  for  charity  are  exceedingly 
annoying  to  the  stranger.  The  houses  are  mostly 
without  fireplaces,  and  comfortable  winter's  lodgings 
for  an  invalid  are  not  readily  procured. 

There  are  two  public  houses  in  this  city,  the 
Hotel  de  France  and  the  Prince  of  Wales,  the  latter 
kept  by  an  English  woman,  which  afford  very  tol- 
erable accommodations. 

Catania.  —  The  site  of  this  town  is  on  the  shores 
of  the  Mediterranean,  and  at  the  foot  of  Mount  Etna, 
in  37°  28'  north  latitude.  The  streets  are  wide, 
straight,  paved  with  broad  flat  stones  of  lava,  and 
the  city  generally  is  neat,  well  built,  and  is  esteemed 
one  of  the  most  pleasant  on  the  island ;  neverthe- 
less, owing  to  the  abundance  of  black  lava,  of  which 
the  buildings,  and  almost  every  thing  else  is  con- 
structed, its  general  aspect  is  dark  and  sombre. 

Catania  has  about  fifty  thousand  inhabitants,  and 
placed  at  the  fertile  base,  or  in  the  first  region  of 
Etna,  the  country  about  is  very  pleasant ;  display- 
ing handsome  gardens,  vineyards,  hedges  of  aloes, 
rich  fields  of  grain,  and  abounding  also  in  choice 
fruits,  as  the  citron,  orange,  olive,  date-bearing 
palm,  peach,  &,c.     There,  too,   good  society,  and 


OF    CONSUMPTION.  247 

the  various  accommodations  of  life  may  be  enjoyed. 
But  the  proximity  of  this  city  to  the  mountain,  ren- 
ders its  climate  uncertain,  and  subject  to  clouds  and 
cold  winds.  The  warm  air  coming  from  the  Med- 
iterranean, saturated  with  moisture,  in  its  passage 
over  the  snow-capt  Etna,  parts  rapidly  with  its  ca- 
loric, and  consequently  deposits  its  moisture  in  the 
form  of  clouds.  This  process  may  often  be  seen 
taking  place  on  the  mountam  in  a  bright  morning 
when  the  wind  blows  from  the  sea.  Thus  at  first  a 
little  speck  of  mist  is  perchance  discovered  settling 
on  its  summit  ;  this  quickly  augments  in  density, 
and  gradually  extends  itself  till,  not  unfrequently, 
the  whole  mountain  is  involved  in  clouds  :  hence  it 
is,  that  sudden  vicissitudes  of  weather,  rains  and 
currents  of  wind,  especially  in  the  spring  season, 
are  so  apt  to  be  experienced.  Though,  therefore, 
the  climate  is  quite  salubrious  for  those  in  health,  it 
is  an  unfitting  winter's  residence  for  the  consump- 
tive, and  I  deem  it  unsafe  for  such  individuals  to 
visit  this  city  prior  to  the  latter  end  of  April. 

Syracuse.  —  In  latitude  37°  2'  north.  This  ancient 
capital  of  Sicily,  once  so  famed  for  its  power  and 
opulence,  and  for  the  lofty  virtue  or  degraded  vice 
of  its  citizens,  now  presents  but  a  melancholy  in- 
stance of  the  devastation  of  man,  and  the  uncon- 
querable power  of  time.  Scattered  ruins — many  of 
them  unintelligible,  —  are  the  only  memorials  of  its 
former  grandeur ;  and,  instead  of  the  twelve  hun- 
dred thousand  inhabitants  once  contained  within  its 
walls,  hardly  fifteen   thousand  remain,    and    these 


248  TREATMENT 

mostly  poor  and  sickly,  cind  the  malaria  irom  the 
neighboring  marshes,  called  forth  by  the  powerful 
influence  of  a  burning  sun,  which  is  said — I  know 
not  with  what  truth,  —  never  to  have  been  obscured 
for  a  whole  day  together,  threatens  to  diminish  still 
more  this  miserable  remnant  of  a  once  mighty 
people. 

Modern  Syracuse  is  included  within  the  island 
of  Ortigia,  and  is  remarkable  for  the  number  of  gates 
and  drawbridges  which  must  be  passed  on  entering 
it.  Its  streets  are  narrow,  dirty  and  uninteresting, 
and  its  buildings  generally  poor.  It  enjoys  but  little 
trade,  though  possessing  a  good  and  easily  accessi- 
ble harbor. 

The  sun  in  Syracuse  is  very  hot,  the  sky  usually 
clear  and  brilliant,  and  consumptive  invalids  gener- 
ally, having  regard  to  climate  alone,  might  dwell 
here  very  safely  and  comfortably  from  the  first  of 
November  to  the  beginning  of  April,  and  enjoy  ex- 
ercise in  the  open  air  with  fewer  interruptions  from 
bad  weather  than  in  most  other  situations  in  the 
south  of  Europe.  For  some  cases  of  phthisis,  how- 
ever, the  clear  skies  and  bright  sun  would,  perhaps, 
be  productive  of  too  great  excitement.  I  found  this 
city  the  hottest  which  I  visited  while  in  Sicily.  But 
then  it  is  so  dull  and  beggarly  a  town,  that  I  appre- 
hend few  invalids  would  be  willing  to  submit  to  the 
inconveniences  and  sacrifice  of  enjoyment  which 
must  necessarily  be  associated  with  a  residence  in 
it.  It  has,  however,  a  very  charmingly  situated 
and  spacious  hotel  —  Albergo  del  Sole,  —  in  which 


OF    CONSUi\IPTIOX.  249 

good  apartments  and  all  needful  comforts  may  be 
obtained;  though,  owing  to  its  want  of  due  support, 
it  is  questionable  whether  its  invaluable  accommo- 
dations will  be  long  afforded  to  the  stranger. 

Messina.  —  This  town  contains  between  seventy 
and  eighty  thousand  inhabitants.  It  is  situated  in 
in  the  Sicilian  strait,  in  38  10'  north  latitude,  has 
an  excellent  harbor,  and  an  extensive  and  handsome 
quay.  It  is  built  partly  on  the  declivity  of  a  hill, 
and  partly  on  a  plain,  and  its  environs  display  a 
varied  and  beautiful  scenery  of  mountains  and  of 
woods.  The  town  is  indeed  backed,  and  in  a  meas- 
ure shut  in  by  lofty  hills,  finely  wooded,  and  more 
or  less  highly  cultivated.  There  is  a  very  pleasant 
walk  along  the'  Marina,  and  drive  to  the  Faro ;  and 
many  interesting  and  romantic  promenades,  always 
of  important  consideration  to  the  invalid,  may  be 
found  in  the  vicinity.  The  streets  of  this  city  are 
well  paved,  some  of  them  broad  and  airy ;  the  pop- 
ulation thrifty,  civil,  and  comparatively  neat;  and 
the  necessaries  and  even  luxuries  of  life  may  be 
procured  here  at  a  moderate  expense.  American 
vessels  frequently  arrive  at  this  port,  and  the  Mes- 
sinians  are  courteous  and  kind  to  our  countrymen. 
The  English  language  is  also  considerably  spoken. 

Messina,  its  neighborhood  being  free  from  exten- 
sive marshes,  is  probably  as  healthful  a  spot  as  any 
in  Sicily.  The  temperature,  however,  is  something 
cooler,  and  high  winds  are  perhaps  rather  more 
prevalent  than  in  Palermo  or  Syracuse.  But  though 
the  climate,  abstractly  viewed,  may  render  it  a  little 
32 


250  TREATMENT 

less  propitious  as  a  winter  abode  for  those  with  pul- 
monic affections,  yet  all  circumstances  taken  into 
the  account,  it  is  a  more  inviting  residence  than 
either  of  these  latter  cities.  The  consumptive  in- 
valid may  tarry  here  from  the  middle  of  October  to 
the  middle  of  April,  after  which  latter  period 
the  temperature  is  likely  to  be  too  warm  for  his 
safety.  Early  in  the  spring,  for  a  short  time,  the 
weather  is  liable  to  be  damp  and  rainy. 

The  dwellings  here,  as  throughout  Sicily,  are, 
with  the  exception  of  a  few  modern  ones,  generally 
constructed  without  fireplaces ;  hence  open  vessels 
of  coals  are  often  employed  in  the  apartments, 
which  must  of  course  greatly  deteriorate  the  purity 
of  the  air.  Usually,  however,  with  some  little  ex- 
ertion a  room  may  be  procured  with  a  fireplace, 
which  indeed,  or  a  stove,  is  absolutely  essential  both 
to  the  comfort  and  safety  of  the  invalid.  The  Brit- 
annia is  a  pleasantly  situated  and  commodious  hotel, 
and  its  master  is  obliging,  and  speaks  the  English 
language. 

Malta.  —  This  island  is  situated  between  Africa 
and  Sicily.  Its  capital.  La  Valetta,  is  in  35  54' 
north  latitude.  Here  the  invalid  may  feel  secure 
of  good  accommodations,  and  as  the  island  is  the 
property  of  the  British  government,  the  English 
language  is  very  commonly  spoken,  and  pleasant 
English  society  may  always  be  enjoyed.  Living, 
however,  is  rather  more  expensive  than  in  Sicily  or 
Italy. 

Malta  is  exposed  to  the  unobstructed  influence  of 


OF    CONSUMPTION.  251 

the  winds  from  the  Mediterranean,  which  frequently 
blow  very  strong,  and  in  winter  and  the  early  part 
of  S]  ring,  the  air  is  oftentimes  uncomfortably  cool. 
I  found  the  weather  here,  in  the  month  of  March, 
more  or  less  cool  and  windy,  with  considerable  rain. 
The  heat  of  the  sun,  too,  is  often  very  intense,  its 
rays  being  reflected  from  a  white  limestone  soil,  and 
few  trees  existing  to  afford  shelter,  or  to  refresh  the 
air  by  their  evaporation.  A  further  objection  has 
been  brought  against  this  island  as  a  residence  in 
consumption,  on  account  of  the  great  quantity  of 
limestone  dust  raised  from  its  surface  in  dry  weather, 
creating  irritation  of  the  lungs.  Still  phthisis  is  not 
a  frequent  disease  in  Malta.  According  to  the 
statement  of  Dr  Hennen,  among  the  English  troops 
stationed  here,  consumption,  on  an  average  of  eight 
years,  occurred  in  proportion  to  other  maladies  only 
as  1  to  931 — and  including  all  pulmonic  complaints 
whatever,  the  proportion  to  others  was  1  to  14. 


CONCLUSION. 


There  are  many  other  places  beside  those  to 
which  attention  has  been  called,  where  the  sufferers 
from  the  malady  under  notice  have  been  more  or 
less  in  the  practice  of  resorting.  Madeira,  at  one 
period,  owing  especially  to  the  favorable  accounts 
given  of  it  by  Sir  John  Pringle,  and  some  other  em- 
inent English  physicians,  enjoyed  a  good  deal  of 


252  TREATMENT 

fame  in  complaints  of  the  lungs.  It  is  now,  how- 
ever, well  known  that  consumption  is  quite  common 
among  the  natives  of  this  island,  and  that  there  is, 
indeed,  some  vice  about  its  climate,  rendering  it 
actually  prejudicial  to  the  phthisical. 

The  West  Indies,  also,  form  a  not  unusual  win- 
ter's abode  in  consumption.  The  heat,  however, 
of  intertropical  countries,  is  generally  too  great  for 
the  disease  when  it  has  become  fully  manifest,  and 
in  a  more  particular  manner,  if  advanced  in  its  pro- 
gress.* 

Yet  in  the  strongly  predisposed,  and  perhaps, 
too,  where  the  menacing  signs  are  just  beginning  to 
discover  themselves,  a  residence  during  the  winter 
on  some  one  of  the  smaller  of  these  islands,  mav  not 
be  devoid  of  utility.  Santa  Cruz  is  very  commonly 
and  I  think  judiciously  selected.  Its  extent  being 
quite  limited,  its  atmosphere  is  more  immediately 
under  the  equalising  and  refreshing  influence  of  the 
ocean.  Indeed,  in  regard  to  the  character  of  its 
climate,  one  will  exist  under  like  circumstances  as 
when  on  shipboard  in  a  corresponding  latitude. 

I  have  been  informed  by  an  intelligent  friend,  that 
Fahrenheit's  thermometer,  during  a  winter  which 
he  spent  on  this  island,  ranged  from  76  to  84  ;  he 
never  having  witnessed  the  mercury  below  the  for- 
mer or  above  the  latter  number.     The  most  com- 

*  '•  The  mean  annual  temperature  of  the  West  Indies,  at  the  level  of  the 
sea,  is  79,  SO  and  dl  degrees  ;  and  during  the  winter  months,  in  some 
places  about  3,  and  in  others  only  2 deg  lower.  The  extreme  annual  ranae 
is  20  degrees,  and  the  mean  daily  ran»e  about  G  degrees." — Copeland' s 
Med.  Diet.     .^t.  Climate. 


OF    CONSUMPTION.  253 

mon  temperature  was  about  halfway  between  these 
two  points.  The  sea  air  was  agreeable  and  refresh- 
ing, and  showers  were  very  frequent  though  of  short 
duration.  The  winds  were  not  high,  but  usually 
just  sufficient  to  be  grateful  to  the  sensations. 
There  was  no  whole  day  during  which  the  weather 
precluded  exercise  in  the  open  air.  The  sun's  rays 
were,  of  course,  very  hot.  No  fires,  as  might  be 
supposed,  are  ever  needed  here,  and  the  dwellings 
being  more  or  less  open,  both  day  and  night,  a  mild, 
fresh  air  from  the  ocean  will  be  constantly  inhaled. 
The  purity  of  the  water  on  this  island  —  rain-water 
being  alone  employed; — cannot  always  be  de- 
pended upon.  ■  Milk,  too,  is  scarce  and  expensive. 
Fish,  however,  are  choice  and  plenty,  and  the  sub- 
acid fruits  —  as  is  well  known,  —  luscious  and  abun- 
dant, forming  a  very  grateful  and  wholesome  diet 
when  no  unnatural  irritability  of  the  bowels  exists. 

It  will  not  be  prudent  for  the  invalid  to  arrive  in 
New  England  —  supposing  this  to  be  his  residence, 
—  from  the  warm  latitude  of  the  West  Indies,  prior 
to  the  middle  of  June.  His  most  judicious  course 
will  be  to  take  passage  in  the  spring,  first  for  some 
southern  port  in  the  United  States,  and  then,  as  the 
season  progresses,  gradually  to  advance  north. 

I  fancy  it  will  be  thought  that  I  have  given  no  very 
flattering  account  of  the  foreign  climates  to  which 
consumptive  subjects  are  in  the  habit  of  repairing; 
but  utility  alone  being  the  intent  of  the  present 
work,  my  aim  has  been  —  omitting  the  common,  and 
too  often  misguiding  panegyrics  on  the  soft  airs,  and 


254  TREATMENT    OF    CONSUMPTION. 

azure  skies,  and  mellow  sunbeams  of  southern 
Europe,  —  to  represent  facts,  so  far  at  least  as  I 
have  been  enabled  to  ascertain  them,  as  they  really 
exist,  feeling  v/ell  assured  that  the  invalid  had  better 
know  the  truth,  the  whole  truth,  beforehand,  and 
so  prepare  hinself  for  the  worst,  than  be  forced  to 
learn  it  by  painful,  and  perchance  dangerous  expe- 
rience. 


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